WHO COUNTRY OFFICE

Annual Report 2020 II WHO UGANDA COUNTRY OFFICE

WORLD HEALTH ORGANIZATION CORE FUNCTIONS

• Articulating consistent, ethical, and evidence-based policy and advocacy positions.

• Managing information, assess trends and compare performance of health systems; set the agenda for, and stimulate, research and development.

• Catalyzing change through technical and policy support, in ways that stimulate action and help to build sustainable national capacity in the health sector.

• Negotiating and sustaining national and global partnerships.

• Setting, validating, monitoring, and pursuing the proper implementation of norms and standards.

• Stimulating the development and testing of new technologies, tools and guidelines for disease control, risk reduction, health care management and service delivery. Annual Report 2020 III

WORLD HEALTH ORGANIZATION STRATEGIC DIRECTIONS

• Continued focus on WHO’s leadership role in the provision of normative and policy guidance as well as strengthening partnerships and harmonization.

• Supporting the strengthening of health systems based on the primary health care approach.

• Putting the health of mothers and children first.

• Accelerated actions on HIV/AIDS, malaria, and tuberculosis.

• Intensifying the prevention and control of communicable and noncommunicable diseases.

• Accelerating response to the determinants of health.

WHO’S MISSION IS TO PROMOTE HEALTH, KEEP THE WORLD SAFE, AND SERVE THE VULNERABLE. IV WHO UGANDA COUNTRY OFFICE

CONTENTS

FOREWORD ...... X

01 HEALTH SECURITY AND EMERGENCIES (WHE) CLUSTER ...... 1

INTRODUCTION ...... 1

ACHIEVEMENTS ...... 7

CHALLENGES ...... 23

LESSONS LEARNT ...... 24

RECOMMENDATIONS ...... 24

02 HEALTH SYSTEMS (HSS) CLUSTER ...... 27

INTRODUCTION ...... 27

ACHIEVEMENTS ...... 28

CHALLENGES ...... 34

LESSONS LEARNT ...... 35

WAY FORWARD ...... 36

03 DISEASE PREVENTION AND CONTROL (DPC) CLUSTER ...... 39

INTRODUCTION ...... 39

ACHIEVEMENTS ...... 40

ANNUAL REPORT 2020 CHALLENGES ...... 51

LESSONS LEARNT ...... 52

WAY FORWARD ...... 52

EDITORIAL TEAM 04 IMMUNIZATION VACCINE DEVELOPMENT (IVD) FAMILY

Chairman AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER ...... 55 Dr. Yonas Tegegn Woldemariam INTRODUCTION ...... 55

Editor ACHIEVEMENTS ...... 56 Mr. Benjamin Sensasi CHALLENGES ...... 69 Members Dr. Annet Kisakye LESSONS LEARNT ...... 70 Dr. Perisic Darinka WAY FORWARD ...... 70 Dr. Bayo Fatunmbi Mr. Esayas Ande Mr. Innocent Komakech

05 WHO COUNTRY SUPPORT CLUSTER (CSU) ...... 73 Layout and Design Allan Batte Introduction ...... 73

Achievements ...... 73

Cover Photo Challenges ...... 82 WHO/Uganda A WHO staff member educates community Lessons Learnt ...... 82 members about COVID-19. Way Forward ...... 83 Annual Report 2020 V

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39 73

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ACRONYMS

ADPG AIDS Development Partners Group EVD Ebola VIrus Disease AfDB African Development Bank FRH Family and Reproductive Health AFENET African Field Epidemiology Network GAVI Global Alliance for Vaccines and AFRO WHO Africa Regional Office Immunizations AIDS Acquired Immune Deficiency GDP Gross Domestic Product Syndrome HBC Home-Based Care AMREF African Medical and Research HC III Health Centre III Foundation HDU High Dependence Unit ANC Antenatal Care HMIS Health Management Information API Application Programming Interface System ARCC African Regional Certification HRAPs Human Resource Action Plans Commission HSDP Health Sector Development Plan ART Anteretroviral Treatment HSS Health Systems BL Biosafety Level IAR Inter Action Review CBDS Community-Based Disease IATI International Aid Transparency Surveillance Initiative CCM Country Coordination Mechanism ICCM Integrated Community Case CEHS Continuity of Essential Health Services Management CERF Central Emergency Response Fund ICU Intensive Care Unit CFR Case Fatality Rate IDP Institutional Development Plan CHEWs Community Health Extension Workers IEC Information, Education and CMYP Costed Multi-Year Plan Communication CoD Cause of Death IEHK Interagency Emergency Health Kit CRVS Civil Registration and Vital Statistics IDSR Integrated Disease Surveillance and Response CRS Congenital Rubella Surveillance IICS Integrated Intelligent Computer CSOs Civil Society Organizations Systems CSU Country Support Unit IMCI Integrated Management of Childhood CTU COVID-19 Treatment Unit Illnesses DANIDA Danish International Development IMT Incident Management Team Agency IOM International Organization for DFID Department for International Migration Development IPC Infection Prevention and Control DPC Disease Prevention Cluster IRS Indoor Residual Spraying DRC Democratic Republic of Congo IVD Immunization Vaccine Development DTF District Task Force JUPSA Joint UN team on HIV/AIDS EFRIS Electronic Fiscal Receipting and KOICA Korea International Cooperation Invoicing Solutions Agency EMR Electronic Medical Record LLINs Long Lasting Insecticide Treated Nets EPI Expanded Program on Immunization MAF-TB Multisectoral Accountability ESPEN Expanded Special Project on Framework for TB Elimination of NTDs Annual Report 2020 VII

MCH Maternal Child Health SARA Service Availability and Readiness MMHF Mayanja Memorial Assessment Foundation SDG Sustainable Development Goals MNCH Maternal Child Health SGBV Sexual Gender Based Vaccine/Violence MNH QoC Maternal New Health Quality of Care SMC Safe Male Circumcision MOV Missed Opportunities of Vaccination SOPs Standard Operating Procedures MRC Medical Research Council SRHR Sexual Reproductive & Human Rights MSH Management Sciences for Health TAT Turn Around Time MTR Midterm Review TB Tuberculosis NCDs Non-Communicable Diseases UAC Uganda AIDS Commission NHA National Health Accounts UDHS Uganda Demographic Health Survey NIPN National Information Platforms for UHC Universal Health Coverage Nutrition UMRESP Uganda Malaria Reduction and NITAG National Immunization Technical Elimination Strategic Plan Advisory Group UN United Nations NMCP National Malaria Control Program UNAIDS United Nations Programme on HIV/ NMS National Medical Stores AIDS NPEC National Polio Expert Committee UNAS Uganda National Academy of Sciences NPEV Non Polio Enterovirus UNFPA United Nations Population Fund NSP National Strategic Plan UNICEF United Nations Children’s Fund NTD Neglected Tropical Diseases UNIATF United Nations Interagency Task Force NTLP National TB and Leprosy Program on NCDs NTF National Task Force URA Uganda Revenue Authority OCV Oral Cholera Vaccine USAID United States Agency for International Development ODK Open Data Kit UVRI Uganda Virus Research Institute PBB Program Based Budgeting VAC Violence Against Children PFM Public Financial Management VCD Vector Control Division PHRCCE Public Health Risk Communication and Community Engagement VHTs Village Health Teams PoCQI Point of Care Quality Improvement VPD Vaccine Preventable Diseases PoEs Points of Entry WCO WHO Country Office PPEs Personal Protective Equipment WHA World Health Assembly PPH Post-Partum Hemorrhage WHE WHO Health and Emergency PSC Programme Support WHO World Health Organisation PSEA Prevention of Sexual Exploitation and WPV Wild Poliovirus Abuse PSM Procurement Supply Management RDT Rapid Diagnostic Tests VIII WHO UGANDA COUNTRY OFFICE Annual Report 2020 IX

Risk Communication and Infection Prevention and Control Consultants educating nursing students on COVID-19. PHOTO: WHO UGANDA X WHO UGANDA COUNTRY OFFICE

FOREWORD

The year 2020 was the most challenging deliver on our technical and logistical mandate for WHO since the opening of the WHO Country of supporting the government of Uganda to Office (WCO) in Uganda. It was the COVID-19 effectively respond to the pandemic. pandemic year that brought all aspects of life to almost a complete halt. Like other public At the same time, we continued to offices, the WCO was equally affected and had support other areas of wok to ensure that to close for the better part of the year. Ugandans do not miss out on the most critical health services despite the pandemic. In this Inevitably, the closure affected our report we highlight our achievements in operation and support to the country as we our areas of work covering Health Systems put more emphasis on supporting the country Strengthening; Health Security and Emergencies; to control the outbreak. Working from home Disease Prevention and Control; immunization, did not only require abrupt acquisition of new vaccine development, family and reproductive technologies but was also a new normal to our health; and WHO country presence. staff accustomed to physical interactions in meetings, consultations, and guidance as they In 2020, socio-economic activities deliver on their responsibilities. including public health were significantly disrupted by the COVID-19 pandemic. However, Suddenly, we had to respond to a fast- in this disruption we identified opportunity as spreading deadly epidemic affecting the entire we leant to develop coping mechanisms to country, not from a central location as we usually the new normal including maximizing virtual do, but from our homes. This was not easy, but capacity building, coordination, and integrated as we indicate in this report, we managed to programming opportunities. We were able to Annual Report 2020 XI

continue office work in various programs even From COVID-19 response we have in the absence of face-to-face interactions. appreciated the importance of prepositioning supplies in districts that are vulnerable to disease We commend our international partners outbreaks. This facilitates easy accesses and who generously contributed financial resources expeditious initiation of response to the various towards our operations and though these emergencies. The same is true for our field we were able to support government on the presence which we intensified by establishing COVID-19 response as well as other areas of regional hub office to support districts. From the public health work. This strong collaboration feedback, we note our field presence provides with partners is a game changer especially in confidence among responders and stakeholders disease outbreaks and we shall endeavor to on the organization and implementation of strengthen it as we move forward. emergency response activities.

We are also indebted to the frontline We report on our activities, challenges, health workers including Village Health Teams lessons learnt and way forward for our office (VHTs) and community members for the operational clusters. We hope that you will invaluable contribution to COVID-19 outbreak enjoy reading the report and give us feedback response. It is unfortunate that some of these on areas we need to improve. gallant colleagues lost their lives in the line of duty but their contribution and dedication to save lives are highly recognized and appreciated. We are committed to supporting government develop community-based structures such as Dr. Yonas Tegegn Woldemariam the Community Health Extension workers and the WHO Country Representative VHTs because they are indispensable in our work. XII WHO UGANDA COUNTRY OFFICE Annual Report 2020 1 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

1

HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

INTRODUCTION

The WHO Emergency program remained pivotal to public health emergencies in the country during the reporting period. Emergency response was undertaken within a delicate context of nationwide containment measures introduced by Government of Uganda to curb COVID-19 spread, and the presidential, parliamentary, and local government election preparations in the WHO staff appealing to student to always later part of the year. Several large-scale public health emergencies including observe COVID-19 COVID-19, Yellow Fever, Cholera, Measles, zoonotic disease outbreaks and the Standard Operating Procedures. protracted crisis of refugees were responded to in the country. Below is the

st PHOTO: WHO UGANDA summary of the caseload from the emergences as of 31 December 2020. 2 WHO UGANDA COUNTRY OFFICE

Public Health Event Confirmed Cases Deaths CFR COVID-19 19 35,511 265 0.75 Cholera 1,269 7 0.55 Measles 46 0 0.00 Yellow Fever 8 6 75.00 Rift Valley Fever 4 2 50.00 West Nile Fever 1 0 0.00 Crimean Congo Hemorrhagic Fever 1 0 0.00

Table 1: Caseload from the emergences as of 31st December 2020.

In all the events, WHO undertook its and providing up-to-date information. The other emergencies mandate as enshrined in the role was to undertake a timely, independent, and Emergency Response Framework including rigorous Rapid Risk Assessment and Situation coordination of the health sector response, Analysis and promotion and monitoring of the ensuring that disease surveillance, early warning application of technical standards and best and response systems are in place, formulating practices. evidence-based health sector response strategies

The Main Public Health Events in 2020

The COVID-19 19 Outbreak

Uganda confirmed the 2019 Coronavirus identified from 135/136 districts in the country. Disease (COVID-19) outbreak on 21 March 2020. Local transmission accounted for 94.4% of Originally, identified in Wuhan, China, the confirmed cases. In total there were 8 outbreak continued to transmit globally testing centers currently in Uganda. affecting over 60 million people However, testing of COVID-19 was causing more than 1.4 million deaths mainly conducted at the Uganda Virus since its declaration as a pandemic by Research Institute (UVRI) and the Central WHO on 11 March 2020. In Uganda, as of Public Health Laboratories. As of 02 January 31 December 2020, the cumulative cases were 2021, 757,764 samples had been tested. Overall 35,511 including 265 deaths [Case Fatality positivity rate stood at 4.7%. However, daily Rate (CFR) = 0.75%]. Confirmed cases were positivity rate was above 5% since July 2020. Annual Report 2020 3 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

Descriptive Epidemiology of the Uganda Outbreak

Time

The COVID-19 outbreak continued to the communities. Prior to the lifting of the lock follow an exponential transmission pattern down and easing of several measures, the in 2020. The transmission followed outbreak was largely contained. Figure a propagated pattern depicting 1 below shows the epicurve for the widespread transmission foci within outbreak.

Figure 1. Epidemic curve of COVID-19 outbreak 21 March to 25 November

Initial peaks were observed in May communities, prisons, health care facilities, 2020 associated with the clusters at Kasensero factories, construction works and traditional fishing village in district. Intense social events such as male circumcision in the actions neutralized the clusters and resulted Elgon sub region. The peaks in November 2020 in a sharp decline and later a sustained low- were associated with cluster of transmission grade transmission until about 27 June when in the schools. The country has observed a government opened informal business to resume significant decline after the cessation of election operations. Since then, there was generally high activities. transmission attributable to congregations in 4 WHO UGANDA COUNTRY OFFICE

Person

Most of the cases were male and among The age group most affected was 26 – physically active groups. Overall, males were 35 years. Reported cases were categorized more affected than females (Figure 2). as 51% alerts, 35% contacts, 5% health This is because in the early phase of the workers, 5% travellers, 2% truck drivers pandemic, almost all the cases were and 2% returnees. male truck drivers. Similarly, many cases were reported among factory workers majority of whom were males.

Figure 2: Distribution of cases by age group

A system for contact identification and tracing was abandoned and so performance follow up was set up in March 2020 around all dropped well below the WHO recommended the confirmed cases. As of 02 January, 2021, a of 85% level for identified contacts. Uganda total of 48,750 contacts had been identified and registered the first health worker infection on listed. Forty-seven thousand one hundred ninety- 27 May 2020. As of 02 January 2021, 1,800 nine (47,199) of the total completed follow up. health workers had been infected with 17 The patients found positive were handed over deaths. Uganda registered the highest number to the case management pillar and were either of health worker infections during last week of enrolled in CTU care for those with moderate November. There was rapid increase in health and severe symptoms or Home-Based Care worker infections which was attributed to non- for those whose symptoms were mild or just adherence to IPC measures and overall increase asymptomatic. After September 2020, contact in community transmission. Annual Report 2020 5 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

Place

There was sustained community Transmission pattern shifted from the majority transmission in at least 120 districts. Most of being cases among truckers identified at Points the districts were in Northern Uganda, mid of Entry to contacts of confirmed cases central region and more recently Elgon, and alerts in the community. This only Rwenzori and Bukedi areas. The highest depicts local transmission. burdened districts as of end of November 2020 are shown in figure 3 below.

Figure 3: The highest burdened districts as of end of November 2020

Uganda protracted refugee emergency

At the end of 31 December 2020, Uganda Burundi 3.4%, Rwanda 1.2%, and was hosting a total of 1,446,378 refugees and others 1.6% (Eritrea, Sudan asylum seekers. Uganda is the largest refugee- and Ethiopia). The refugees hosting country in Africa, and the third largest in are hosted in 12 districts the world, after Turkey and Pakistan. The refugees spread across the country. originate from South Sudan 61.4%, DRC 29.2%, 6 WHO UGANDA COUNTRY OFFICE

Ebola Virus Disease outbreak

Uganda continued with its preparedness an essential component of the response with and readiness activities to prevent the spill the strategy to immunize contacts, contact of over of the Ebola Virus diseases until the contacts and frontline workers. Seventy- 10th DRC outbreak was finally declared eight (78) contacts, 747 contacts of over on the 25 June 2020. The country contacts and 682 front line health imported cases and contacts in 2019. workers were vaccinated under the On 11th June 2019, Uganda confirmed compassionate use protocol. its 6th EVD outbreak from the spill over which resulted in 4 cases including 04 deaths. Overall, the following are the major The 04 cases generated a total of 123 contacts, achievements, challenges, and lessons under the these were followed up for 21 days; with Health Security and Emergency Cluster. none developing symptoms. Vaccination was

A WHO Risk Communication team member educating Boda Boda riders about COVID-19 PHOTO: WHO UGANDA Annual Report 2020 7 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

WHO Staff having his temperature measured in the field. PHOTO: WHO UGANDA

ACHIEVEMENTS i. COVID-19 outbreak preparedness and response

Coordination

COVID-19 coordination is undertaken • WHO was instrumental in coordination by the Strategic Advisory Committee advised at the strategic, Incident Management by the Scientific Committee (strategic), Incident Teams and in the districts. At all the levels, Management Team (operational) and District Task WHO provided technical guidance to the Forces (tactical). The IMT is responsible for the day- Ministry and actors for effective response to-day review of COVID-19 outbreak response at coordination and technical quality in the national level. At the district level, coordination is response. in the hands of the DTF and the Rapid Response • A total of 15 short term staff were Teams. Overall, clearance of the response decisions recruited and deployed in eight WHO is done at the National Task Force chaired by Office strategic response support hubs including of the Prime Minister. The following were the main (02), (03), Arua (01), Hoima achievements: 8 WHO UGANDA COUNTRY OFFICE

(01), Rwenzori (02), (02), South the country to uniformly kick start the Western region (02) and /Wakiso response, the efficiency of approaching (02) with the funding from Irish Aid. the response from a decentralised point In addition, two epidemiologists were of view, the innovations to involve engaged to support Kampala and Wakiso communities and key stakeholders in the for technical backstopping to the Incident response from onset and the charismatic Commander and IMT in terms of ensuring leadership offered by government in that the outbreak response information support of the response. The challenges are well organized and available, Sitreps highlighted included weak linkage of and presentations are prepared for the IMT and other coordination structures, IMT meetings. Additional twenty-five (25) erratic supplies of lab reagents, essential short term expertise were hired and patient care commodities and deployed to support the districts in Personal Protection Equipment and quick emergency response using a problems related to evacuation grant from DANIDA. The staff were of severe patients. The review deployed strategically in 08 hubs. recommended strengthening of the decentralization of the response actions, • WHO supported the Ministry of Health to scaling up the operationalisation of HBC, conduct the Inter Action Review (IAR). The strengthen supply chain management IAR was conducted from 30 November and improvement of sample shipment to 5 December 2020. The IAR employed arrangements. The others were limitations a “whole of government approach” to in contact tracing and inadequate assess the country’s COVID-19 response synchronized deployments. thus far. The assessment was conducted at National and at District Level, in eight • WHO also supported the coordination of (8) districts of Amuru, Buikwe, Kampala, the UN technical team on COVID-19 and Kikuube, Lira, Mukono, Pallisa, and conducted regular donor and bilateral Wakiso. The exercise unearthed the strong partners engagements. dividends obtained from the investments in previous preparedness activities particularly EVD and IDSR which enabled Annual Report 2020 9 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

Surveillance

The Surveillance pillar for COVID-19 was organised into Alert Management, Contact tracing, Case investigation, Quarantine, and laboratory and reports to the IMT. There is a central team that supports the districts. The pillar received support from several technical partners. Surveillance was supported by a network of laboratories. Epidemiological surveillance was central in the COVID-19 response. Below were the main achievements:

• WHO assigned dedicated staff at both implementation of quarantine according the national and district level to support to government guidelines and Isolation the response. Of the total staff recruited, and care of the confirmed cases. 07 epidemiologists were dedicated • In all the districts, alert management to primarily support surveillance at system was well set up and linked to the the nationals and district level. The case management teams. WHO partnered epidemiologists were allocated to Mbale with AMREF and AFENET to manage (01), Gulu (01), Arua (01), Rwenzori (01), the downstream implementation of a Masaka (01), and Kampala/Wakiso (02). robust alert system with the districts. All • At national and district levels, the districts were enrolled and supported to epidemiologists conducted orientation report alerts identified and responded to of surveillance teams on COVID-19 through the Open Data Kit. Working with case detection, setting up of the district teams, reporting to national the contact tracing and follow level improved from about 20% of up systems and supported districts in April 2020 to 69% of alert arranging for risk-based testing as an the end of November, 2020. In in the high transmission areas of 55 districts, AFENET mobilised 478 RRTs Mbale, Amuru and Kyotera/. to support alert management set up in all the districts; with alert desks and standby • WHO supported the Ministry of Health phones. Through this arrangement, to conduct case investigations across AFENET, verified and investigated 81% the country. During the reporting period, (37,495/ 46,186) of all the alerts; 369 the case investigations identified and being death alerts. A total of 3,695 of the supported neutralization of at least 06 alerts had samples collected which turned clusters of transmission in Gulu, Manafwa, out positive for COVID-19. In cosmopolitan industrial park in Mukono, Kampala, being the country’s highest Aswa power project in , a transmission centre, 99 officers were major Steel industry in engaged to support alert management. and Moroto Prisons. In all the places, The graph [next page] illustrates alert WHO officers worked with the districts to reporting from the AFENET program. neutralise the clusters through effective identification and follow up of contacts, 10 WHO UGANDA COUNTRY OFFICE

16500 15631 10490 11406 8659 6500

-3500 August September October November

Alerts received

Figure 4: Alert Reporting per month

Figure 5: Alert Reporting per month

• In addition, WHO and AMREF supported be responded to in the Acholi sub-region. the 08 districts of Acholi sub region to The district surveillance focal persons implement a robust alert management were facilitated with fuel to conduct system with funding from DANIDA. further investigations and follow up of the Each district was provided with mobile alerts. phones loaded with monthly airtime. The • Hospital based surveillance was also districts received furniture comprising rolled out to some of the regions, of three chairs and one table each and prominent of which was Acholi (Gulu) stationery to record alerts coming in from sub region. However, this was not scaled the community. Each district had a team up due to shortage of commodities, and of five Rapid Response Team members to the subsequent change in testing strategy verify and respond to alerts. This led to for enrolment of persons into COVID-19 confirmation of 2,825 (80%) of alerts to testing. Annual Report 2020 11 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

• Contact tracing which involved contact was largely outstretched and there was identification, listing and follow up was the eminent need to support shipment considered critical in the containment of samples to the referral laboratories phase of the response. WHO worked (Uganda Virus Research Institute and actively with the Ministry of Health to Central Public Health Laboratories) develop through apprenticeship standby located close to the capital of the country. capacity that became core in supporting Upon a request from the IMT, WHO districts to set up contact tracing for all provided 12 vehicles (later reduced to the exposed person. At the beginning, six) to support transportation of samples. local responders were largely inadequate Six (06) Points of Entry namely Elegu, in terms of numbers and skills to be able Mirama Hills, Busia, Mutukula, Malaba to support the districts to deliver the scale and Mpondwe were each supported with of contact tracing required for the new standby transport to move the samples emergency COVID-19. WHO supported to the reference laboratories. The support the Ministry of Health with 15 short term to the Ministry of Health with transport hired vehicles each provided with at least enabled 228,128 (50.3%) of the total 20 litres of fuel per day for a period of 453,593 sample shipped to the testing 3 months to support contact tracing. laboratories and this arrangement went Contact tracers received internet data and on up to 31st December 2020. phone credits to facilitate daily reporting • A total of 43 points were identified and follow up in Go data system. From by the country for intensive screening May to September 2020, a total of 48,750 of all the travellers. WHO and IOM contacts were listed and successfully supported implementation of a number of followed up. This accounted for 95 – 97% interventions to strengthen the capacity of the contacts followed up in that period. of the Ministry of Health to effectively However, the Ministry of Health changed manage the PoEs. The interventions over to a mitigation strategy and most targeted Busia, Malaba, Mutukula and entities largely abandoned contact tracing Elegu PoEs. Overall, 36,266 people were despite the successes. screened at the PoEs during the reporting • Turn Around Time (TAT) for results of period. Ninety-three frontline responders lab samples was problematic from the at PoEs were trained on COVID-19 very beginning of the response. At the information management, data capture border crossing points of Malaba, Busia, and reporting. In addition, 07 PoEs Elegu, Vurra, Mpondwe, Mirama hills and received equipment and supplies such Mutukula among others drivers were Personal Protective Equipment (PPEs), required to wait for results of COVID-19 infrared thermometers, and hand sanitizer tests before entry into the country. The for the frontline responders, volunteers, national transport system for samples facilitator and health promoters working 12 WHO UGANDA COUNTRY OFFICE

at the PoEs. At the same time, 12,679 IEC • In view of the supplies pipeline challenges, and promotional materials on COVID-19 WHO partnered with the UK Medical were distributed to the PoEs and border Research Council (MRC) and the London communities. The COVID-19 messages School of Hygiene and Tropical Medicine were adapted to the local context and to procure kits and related accessories languages. As a result, 36,266 people supplies adequate to conduct 100,000 who were screened were provided with tests. The KITS were availed to the Ministry preventive behaviour messages on of Health testing centres following an COVID-19, hygiene and sanitation at allocation plan endorsed by the Director Boarder points of entry thus registering a General of Health services. high success rate.

WHO staff interacting with soldiers on COVID-19 prevention. PHOTO: WHO UGANDA Annual Report 2020 13 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

Community Engagement and Risk Communication

Risk communication is core to promoting • Trained Community Health Workers and positive behaviour practice and to reduction of the Local Council structures in PHRCCE risky behaviours. At risk traveller and the public and COVID-19. were the main audience for the risk communication. • Regularly reviewed and disseminated Attention was paid to the sensitization of the COVID-19 messages across various media various stakeholders with the intention to identify – Radio, TV, print, outdoor and social and dispel myths about COVID-19, build media. consensus on appropriate risk prevention behaviours and promote actions that • Developed SOPs for different reduce misconceptions and to ensure that audiences and settings. audience supported the response efforts • Conducted [online and promoted in their communities and country. community] assessment to establish Below are the main achievements: people’s Knowledge, Attitudes, • Revised the National Public Health Practices, and perceptions on SoPs. This Risk Communication and Community informed strategy development and its Engagement (PHRCCE) Strategy to focus Implementation. on increasing community participation.

A VHT member conducting social mobilization against COVID-19 PHOTO: MoH 14 WHO UGANDA COUNTRY OFFICE

• Set up and functionalized the Public Risks • Developed and printed assorted IEC Communication coordination at national material to support risk communication in and district levels. the field. The materials are broken down as 200,000 posters, 169,000 leaflets 20 • Engaged stakeholders to support PHRCCE pull up banners. for COVID-19. • In the Acholi sub region, WHO supported • Implemented practical ways to build broadcast of radio announcements and Community trust (Shift COVID-19 message spots on Gulu FM, Tembo FM and Might dissemination from MoH to community Fire FM in Kitgum promoting COVID-19 influencers; the Queen of , MTN prevention standard operation procedures. Uganda a telecom company, celebrities Overall, 300 radio announcements and and artists and provided daily press 30 radio spots were aired in the morning releases. Other interventions include and evening daily. By end of November Responsive social media engagement and 2020, the broadcasts were complete and operation of functional toll-free helplines. approximately 5,810,000 people were • “Tonsemberera” (Keep a Distance reached with the messages in the sub Campaign) was successful multi-media region. This improved responsiveness of campaign that was implemented to the communities in identifying alert cases promote COVID-19 prevention and control and reporting them to the health staff. measures and SoPs.

Case Management

Case management was very central to the COVID-19 response in 2020. The team support patient care through a network of 18 treatment centres and six Non Tradition Isolation Facilities. These included all the regional referral (Lira, Gulu, Arua, Hoima, Fort Portal, Mubende, Kabale, Mbarara, Masaka, Naguru, , Jinja, Mbale, Soroti and Moroto). Additional hospitals included National Referral hospital, Adjumani and Bombo General Military Hospitals. Non- traditional treatment centres were organised in National Stadium (Namboole), three Uganda Prison centres at Gulu, Jinja and Moroto, Aswa Electricity Power dam and Kyangwali refugee settlement. At the end of December, total admissions were 256 in the HDU and 160 in the ICUs. Trained health workers (non- specialists) and specialists were always available to manage moderate and severe cases to achieve desirable patient outcomes. The country has a total of 144 ICU beds with associated equipment but out of these only eight are currently functional. Below were the main achievements:

• WHO hired roving specialist’s health specialists covered the regional hospital workers (03 anaesthesiologists and 02 ICUs where non-specialised staff were critical care nurses) to provide on job trained. The skills gained enabled the mentorship and technical backstopping health workers to task shift and utilize for care at the sub-national level. The available equipment in HDU and ICUs. Annual Report 2020 15 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

• WHO also supported the training of • Eleven short term staff were recruited 15 health workers (doctors, nurses, and deployed to enhance provision of paramedics and IPC specialists as well care using a grant from Irish Aid. The as the Police Air crew) in advanced care funding enabled WHO to identify, engage and medical evacuation for COVID-19 and deploy one competent Incident using the epi-shuttle. Participants were Commander and nine other specialists drawn from MoH Emergency services including four case management department, IOM, UN clinic, experts, three surveillance, two Risk City ambulance, JMEDICC Communication and one Infection and the Ugandan Police Air Prevention and Control officers. The case Wing. The specialists required management specialists were deployed equipment to be able to in Gulu, Mbale, Hoima and Kampala. The function effectively in the care specialists also trained over 3000 health of the moderate and severely ill patients. workers on the care for asymptomatic and Procurement of the WHO device kit (100 mild cases in 75 districts that are covered patient module) to supplement the centre by the WHO hub system. for care of patients with COVID-19 was • In addition, WHO using a grant from also made with a grant from Irish Aid. All DANIDA engaged University supplies were handed over to the Ministry Lung Institute to conduct a training of of Health.

A labaratory technician testing a laboratory light. PHOTO: WHO UGANDA 16

A WHO team member taking Health Centre Workers of Hospital through procedure, like vaccine management, temperature monitoring, using fridge tags, correct recording and the use of EPI tools like the Child Register. PHOTO: WHO UGANDA

510 health workers from 26 districts • Lifesaving commodities and patient care on COVID-19 case management which facilities for COVID-19 response were boosted capacity in these districts to required at national and sub-national level. manage COVID-19. Using DANIDA funding, WHO supported the Ministry of Health with essential • Availability of essential lifesaving supplies for use in the intensive care unit equipment was made possible through of Mulago National Referral Hospital and funding from DANIDA which enabled COVID-19 treatment centres. Four (4) ICU WHO to procure 400 oxygen regulators, equipment, ten (10) airway breathing 1000 non-rebreather bags, 5000 nasal management devices, ten (10) airway prongs, 65 pulse oximeters and 49 oxygen tubing and filter devices, 31 priority ICU concentrators. High admission rates and drugs, 12 circulation support and point of demand for care characterised COVID-19. care diagnostic supplies were procured. Demands for more bed space was These supplies contributed immensely to overwhelming for the response especially improved care of the severe and critically towards the end of the year. Therefore, ill COVID-19 patients at Mulago hospital procurement of 130 beds, 100 mattresses, and in the country. In addition, assorted 300 bed sheets and 150 blankets for the supplies for patient care and IPC were Ministry of Health was timely. procured and distributed to all the 14 regions. Annual Report 2020 17 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

• WHO also supported the Ministry of and Mulago hospital treatment care Health to conduct Ambulance referrals centers for further management. The working in partnership with AFENET. A Gulu Regional Referral Hospital (GRRH) total of 131 ambulances were deployed ambulance team evacuated 21 cases from to evacuate suspect cases during alert the 8 districts to GRRH and to Namboole management operations. The ambulance treatment centers. evacuations were distributed as follows • With funding from DANIDA, WHO procured Bududa (10), (4), Mbale (10), four heavy duty washing machines which Masaka (14), Rakai (7), Kalangala (2) and were installed at Gulu, Mbale, Lira and Wakiso (80). Soroti referral hospitals to reduce the risk • WHO and AMREF supported Kitgum, of nosocomial infections through handling Lamwo, Nwoya, Pader, and of linen. Gulu districts in the Acholi sub region • COVID-19 care generated a lot of to operationalise ambulance service waste posing a potential risk for health for COVID-19. This was made possible facilities already challenged with waste through a funding from DANIDA and management. WHO and Baylor College under this support AMREF working of Medicines Children’s Foundation with WHO field IPC technical team using a grant from DANIDA constructed oriented the local ambulance teams. and installed four (4) MAK IV model A total of 28 (23 male and 05 Female) incinerators at Tororo Hospital and at officers were equipped with knowledge Malaba, Mutukula and Busia PoEs and and skills in handling highly infectious at Soroti Regional Referral hospital. At cases in preparation for evacuation. The all the sites, operators were trained and ambulance teams were able to evacuate equipped for the job. 1623 positive cases to Gulu, Namboole

ii. Consolidation of Ebola Virus Disease (EVD) readiness interventions in high-risk districts

Coordination

• WHO maintained active field operational IPC, case management and district presence in eight hubs (Mbale, Moroto, coordination consultants. From the field Gulu, Arua, Hoima, Rwenzori, Rukungiri, hubs, districts within the regions were Masaka and Kampala City Council actively reached whenever required, Authority) providing support to over implementation of public health 84 districts with funding support actions were technically supported, from AfDB. The hubs were staffed and districts were provided with by short term consultants; one needed commodities. The field epidemiologist, Risk communicator, team actively supported each of 18 WHO UGANDA COUNTRY OFFICE

the district response pillars to maintain a or were readily available to convene at robust preparedness throughout the active short notice in case of any suspected EVD and transition phases of the outbreak. All events. All the technical teams had pillar alerts were promptly enrolled, verified members assigned, trained and were and resolved based on set criterial for readily available to deploy at short notice all EVD related events. In at least 70% of in case of an EVD event. At national level, the district, EVD preparedness plans were NTF continued to be supported to review discussed and finalised and approved by the EVD situation in the high-risk districts the DTFs. Most of the DTFs were well from time to time. mobilized and remained functional and

The Nabagereka (Queen) of Buganda Kingdom helped to mobilize people for action against COVID-19 under tthe Tonsembelera (Don't come near me) campaign 19 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

An elderly man displays his card after receiving the Yellow Fever vaccine. PHOTO: WHO UGANDA

Infection Prevention and Control

In partnership with WALIMU and funding grant from African Development Bank (AfDB), the following achievements were made: • Six trainers were mobilized and deployed EVD’. A total of 420 health workers were to instruct at each of the 14-training trained in the 14 regional hospitals: site to deliver a tailored training Moroto, Mbale, Soroti, Gulu, Lira, curriculum ‘Triage, Emergency Mubende, Hoima, Masaka Fort care and management of Severe Portal Mbarara and Kabale, Arua, Illness in the context of COVID19 and Jinja and Naguru. 20 WHO UGANDA COUNTRY OFFICE

• The high-risk districts of Kasese, • Three emergency deployable tents that Bundibugyo, Ntoroko, Bunyagabu were previously installed at Bwera and and Kasese were provided with one Bundibugyo hospitals and at Rwebisengo comprehensive Interagency Health kit HC III were refurbished. The works each enough to support 30,000 people involved partitioning, improving aeration, for 3 months. Another five supplementary renovation of ablution facilities such as Interagency Health Kit and 20 Malaria latrines and bathrooms and repair of the kits were procured and distributed to the fencing. high-risk districts. • In addition, WHO and Baylor College • WHO set up and operationalized triage of Medicine Children’s Foundation in 14 regional hospitals as seen in the with funding from AfDB installed two picture below from the Hoima Regional incinerators (Gulu and Moroto Regional Referral Hospital triage tent. Drills in all Referral Hospitals). The incinerators were the 14 regional referral hospitals were commissioned by Honourable Dr. Joyce also undertaken. Moriku Kaducu, Minister of State for Health).

Surveillance and alert management

• WHO and WALIMU in collaboration follow up program in the Rwenzori areas with the Ministry of Health supported under which 1,814 VHTs were followed Wakiso and Kampala districts to train through 108 meetings. A total 62 health workers on Community- of 156 health workers were based Disease Surveillance. Overall, oriented as supervisors and on 751 VHTs Kampala (341) and Wakiso the operation of the Open Data (410) underwent a three-day training. Kit in Kasese, Bundibugyo and Ntoroko districts. • WHO and Mayanja Memorial Hospital Foundation (MMHF) implemented a VHT

COVID-19 Infection prevention and control targeted health education for clients at the antenatal clinic in Padibe HC IV, . PHOTO: WHO UGANDA Annual Report 2020 21 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE) iii. Cholera outbreak in Karamoja sub region

Karamoja is located north-east of Parish, Nadunget sub-county, , Uganda and is about 512 Km from Kampala. It Karamoja region were admitted. The outbreak is largely semi-arid and inhabited by nomadic spanned 4 districts including Moroto, Napak, pastoralists with no permanent households Nabilatuk and Kotido. The region experienced or toilets. The last outbreak in the region was two Cholera outbreaks in four out of the nine in 2018 in Moroto with a handful of cases. On districts in the sub region with 1614 (CFR=1.1% this occasion, following vandalised solar water -18/1614). pumps in Moroto village, residents used a lot of pond filtered water and reportedly used water in From the outbreak investigation, use reservoir meant for their cattle. of contaminated water in ponds was the environmental source of the vibrio cholerae. Cholera outbreak was confirmed on 16th Reactive OCV vaccination amidst COVID-19 May 2020, however on 28th April 2020 index helped curb the outbreak in June and August suspects from Natapar Kocuc village, of Loputuk 2021.

Descriptive epidemiology of the Karamoja outbreak

Time

Two outbreaks one from 28th April to and Napak which were more affected recorded 27th October and a brief one from 28th reduced cases as indicated in the combined November to 3rd December 2020 epicurve. By 14th November 2020, there were recorded. They were propagated were no cholera cases recorded in the outbreaks with the highest peak region indicating that the outbreaks had occurring on 15th May 2020. Between been successfully controlled. 16th May and 20th June, Moroto, Nabilatuk

Place

The index case for first outbreak was a two of her of household contacts were referred 27-year-old lady from Natapar Kwangan village, to Loputuk CTU the next day, this cluster of cases Loputuk parish, Nadunget sub-county, Moroto was reported to WHO and district authorities district. Overall, 24 cultures were positive (7 who together with the health facility staff tested Moroto, 11 Nabilatuk, 2 Napak, 4 Kotido) tested the suspects using the Cholera RDTs. form the Central Public Health Laboratory Another four people were (CPHL). admitted on 30th November 2020 For the second outbreak, the index case and they tested positive on the RDT. was a 31-year-old female from Nachuka village, A total of 110 contacts from three Lotirir parish, Nadunget sub-county, Moroto villages were identified and followed District who was seen at Lotirir HCII on 28th up from 2nd December 2020. Samples were November 2020 with Acute Watery Diarrhoea taken off and tested the CPHL on 3rd December (AWD). She was treated at Loputuk HCIII as a 2020 with results indicating negative (No culture suspected Cholera case and improved. When growth) as the patients had taken antibiotics. 22 WHO UGANDA COUNTRY OFFICE

Person

Children under 5 years were and of those six were community deaths. predominantly affected. Overall, males Moroto had six deaths of which three were affected more than females as well were community deaths. Four of the 18 as mothers aged 20 to 34 as well as deaths were children under 18 years grandmothers above 60 years. There were and 11 were women. 18 deaths of which 10 occurred in Kotido iv. Response to Floods

Through CERF rapid response allocation, for community disease surveillance. Through WHO and its partners provided emergency these VHTs, a total of 21,591 patients were lifesaving services to 160,103 individuals who assessed and referred by the VHTs. This averted were affected by floods. Overall, 49,924 patients undesirable outcome which could have resulted received emergency outreach services, that is, from late or none seeking of care for the children. 17,764 in Bundibugyo, 15,122 in Bududa and 17,038 in Sironko districts. The Village Health A total of 7000 Long Lasting Insecticide Teams (VHTs) treated 47, 681 patients using Treated Nets were distributed to expectant the Integrated Community Case Management mothers in the facilities in the floods affected (ICCM) and 62,498 individuals benefited from areas. This contributed to protection of the the Oral cholera vaccination exercise. mothers and their children from Malaria. The following activities detailed in the table below In addition, the project empowered were implemented in response to the floods 2,491 VHTs to manage ICCM (1771) and 720 emergency.

Table 2: Support to Flood Affected Districts

Orientation of VHTs on Community Based All 600 VHTs were trained and supported to disease Surveillance. conduct community surveillance.

Five (05) cholera kits were procured and Procurement of cholera kits. dispatched to affected districts.

Coverage of 80% of the population was Oral cholera vaccination exercise. achieved.

216 EMOs (72 in each district), serving 49,924 Conduct emergency outreaches. patients (17,764 in Bundibugyo, 15,122 in Bududa and 17,038 in Sironko).

Staff were recruited and deployed in Rwenzori, Deployment of surge of health staff. Mbale area.

Distribution of 05 Trauma kits, 130 Beds was Procurement of (LLINs, IEHK, Trauma, beds). done

Supervision and monitoring of activity Supervision was done in all the districts. implementation. Annual Report 2020 23 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE) v. IHR (2005) implementation

• Integrated Diseases Surveillance and by 36 National Rapid response Teams Response 3rd Edition roll-out was initiated trainers as part of the sustained capacity with the adoption of technical guidelines building for public health emergency and training materials. A working group response in the districts. to rollout the strategy was formed with • The MoH developed plans for Pandemic active participation of WHO. Funding was Influenza Preparedness and vaccine secured to for implementation to start in deployment. The plans will enable 2021. the country to implement the non- • WHO supported Ministry of Health to train pharmaceutical interventions that are the and facilitate 714 Rapid Response Teams lifeline of care before vaccination. across the 136 districts. They were trained

vi. Refugee Emergency

• Through CERF funded window, WHO and for all emergencies, critical gaps in IPC its partners provided critical assistance to practice and requirements in the health over one million beneficiaries by averting facilities, building of two incinerators in avoidable mortality due to the various Lamwo district and provision of lifesaving ailments in the refugee settlements. commodities and logistics. SARA survey The funding enabled the training of 470 was also conducted to guide responders Village Health Teams on Community to tailor humanitarian responses to the Based Surveillance and electronic needs of the affected population. reporting. Additional aspects addressed by the grant included alert management

CHALLENGES

• COVID-19 outbreak disrupted • Overall, commodities for emergency implementation of many WHE programs response were in short supply which and affected timeliness of response to resulted in very long lead time of up to 8 some of the outbreaks especially Yellow months and piecemeal deliveries. Fever, Cholera and Measles. 24 WHO UGANDA COUNTRY OFFICE

• National and district coordination systems • There was overwhelming demand on were overwhelmed by the requirement WHO to deploy technical expertise to for protracted response. In some of the support sub-national response activities. situations, new coordination structures • Over reliance on other partners for were created but not synchronized across warehousing created limitation on access board. to commodities at critical moments and • Existing outbreak response systems were temperature control challenges in some largely abandoned during the COVID-19 of the stores. This resulted in scattering response which created a system in commodities and supplies to various which local responders had to work with places which increased handling and hurriedly set up structures which were not storage costs. efficient.

LESSONS LEARNT

• Catalytic funding of selected core activities health enables expeditious initiation of is critical in ensuring prompt initiation of response to the various emergencies. This emergency response. provides confidence among stakeholders on organization of emergency response. • Strong partnerships between WHO and the local donor partners is core to the • Strategically located field presence allows mobilization of resources for the various effective on-site support to districts on a emergencies. sustained and regular basis. This improves the quality and results of emergency • Availability of prepositioned supplies public health response at the sub-national readily accessible by the Ministry of level.

RECOMMENDATIONS

• WHO and partners should support • WHO should identify and hire a warehouse the Ministry of Health to develop and that is easily accessible at all times and implement a post COVID-19 transition spacious to enable efficient inventory intervention plan. The plan should be management. informed by a robust After-Action Review • WHO should explore innovative ways to of the response. field fleet management. • WHO should maintain selected field hub • WHO and partners should support the offices staffed by multi-skilled emergency Ministry of Health to review the mapping staff able to quickly support sub-national of the cholera hotspot areas based on the public health emergency response. experience and achievements of 2020. Annual Report 2020 25 HEALTH SECURITY AND EMERGENCY CLUSTER (WHE)

The Burial Team burying a person who died of COVID-19 in . PHOTO: WHO UGANDA 26 WHO UGANDA COUNTRY OFFICE Annual Report 2020 27

2

HEALTH SYSTEMS

STRENGTHENING CLUSTER (HSS) HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS)

INTRODUCTION

The HSS cluster aims to support the strengthening of the health system for effective, equitable and quality health service delivery. WHO undertook to support national efforts to build a resilient health system able to deliver Universal Health Coverage (UHC) by protecting human life and producing good health outcomes. Physical activity promotes good health and growth. In 2020, under the Health Systems Strengthening Cluster the WHO Country Office

PHOTO: WHO UGANDA achieved the following towards attainment of UHC. 28 WHO UGANDA COUNTRY OFFICE

The Jinja bridge was lit in 2020 in commemoration of World Patient Safety Day. PHOTO: WHO UGANDA

ACHIEVEMENTS i. Health Technologies and Commodities

• Strengthened the Ministry of Health technical support to the development of leadership and governance of the the Institutional Development Plan and Pharmaceutical Sector by undertaking following up on its implementation. The the review and updating of the National IDP was developed following a WHO Pharmaceutical Sector Strategic Plan for assessment of the capacity regulatory 2020/21 to 2024/25, which is the tool that functions during the preceding year. not only provides direction to but also • Strengthened the Ministry of Health galvanizes partners around a common leadership and governance of the health purpose. sector by providing technical inputs • Improved access to medical to the development of the Health products that were deployed Sector Development Plan II for the for the COVID-19 response by period 2020/21 to 2024/25. This providing technical oversight to tool provides the overall strategy and national forecasts and quantification direction for the health sector. and also actively engaging in the logistics • Promoted coordination of partners through pillar deliberations. providing technical and administrative • Strengthened the national medical support to maintain the secretariat of the products regulatory function by providing health development partners’ group. Annual Report 2020 29

ii. Health Promotion and Public Information

• Throughout the year, WHO was at the of COVID-19 cases towards the end of center of COVID-19 outbreak and Health the year were: regular hand washing with Promotion (Risk Communication) was soap and water, correct and consistent fully repurposed as one of the major wearing of masks, physical distancing and response pillars within and outside early seeking of medical care. the office. In that capacity, WCO was • Direct community fully represented on the National Risk engagement was central to Communication subcommittee of the HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS) WHO support and for this, the Incident Management Team (IMT). office recruited and deployed • Through these subcommittees the ten risk communication consultants office contributed to the drafting and who helped districts to strategize for implementation of the Risk Communication community engagement leading to Response Plan under which a number desired results. The consultants managed of activities were technically supported, to orient and involve community structures such as VHTs on COVID-19 in addition funded or directly implemented. The to identifying high risk individuals, important behaviours promoted that communities and settings for action. contributed to the significant reduction • The office actively participate in the development of Information, Education and Communication (IEC) materials that were successfully used in the COVID-19 response. These included posters, leaflets, fact-sheets, talking points, question and answer booklets, horizontal banners, pull-up banners, Standard Operating Procedures, radio spots and announcements as well as television messages.

• Aside from COVID-19 the office worked with the ministry of health to plan the piloting of the Community Health Extension Workers (CHEWs) project that will be done in four districts, i.e. Mayuge, Lira, Kyotera and Kabarole starting in 2021. This work involved preparation and finalization of plans, documents, and budgets.

A Village Health Team Member mobilizing communities against COVID-19. PHOTO: WHO UGANDA 30 WHO UGANDA COUNTRY OFFICE

• Public information for WHO visibility was to field teams, partners and stakeholders undertaken with production of bulletins, to enhance WHO visibility. Particular website content and consistent presence emphasis was put on highlighting WHO on social media. A number of short field contribution on COVID-19 and high-impact videos as well as visibility regular briefing of journalist to enable materials were produced and distributed them report accurately on the outbreak.

A WHO risk communication team member answering questions on COVID-19 on a community FM radio station in . PHOTO: WHO UGANDA

iii. Analysis, Use and Access to Routine Facility Data

• Supported routine analysis of training, in which key principles, terms administrative facility data to inform early and processes for medical certification of detection and response to epidemics, cause of death, ICD-11 and verbal autopsy periodical monitoring of sector were explained; how to use the WHO medical certificate of cause of death programme performance, including to assign the cause and events informing quarterly and annual leading to death; use of the online sector performances. ICD-11 browser and coding tool to • Strengthened the country capacity accurately code diagnoses of diseases to improve the quality of mortality and of cause of death; and the use of the statistics in the context of COVID-19. verbal autopsy tool to assign a cause of This was done through a virtual regional death. Annual Report 2020 31 HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS)

A nurse gives out medicine to a patient at Masaka Regional Referral Hospital. PHOTO: WHO UGANDA

• Convened a country team, comprising the status of CRVS in the country, areas of the Ministry of Health, the National that were performing well and those that Identification and Registration Authority needed improvement. These included the and the Uganda Bureau of Statistics to completeness and functioning of CRVS; conduct a rapid assessment on the status cause of death (CoD), reporting and of implementation of WHO-FIC in Uganda. generation of statistics. The rapid assessment tool highlighted

iv. Monitoring Service Availability, Quality and Effectiveness

• Worked with MoH to develop a Monitoring essential medicines, infrastructure and and Evaluation Framework and Plan other resources) and readiness of for the Health Sector Development health facilities to provide basic Plan 2020/21 – 2024/25. healthcare in seven refugee hosting districts in Uganda. This followed • Conducted a service availability and an influx of refugees that presented readiness assessment (SARA) to assess various challenges on service delivery in service delivery, availability (diagnostics, the refugee-hosting districts. 32 WHO UGANDA COUNTRY OFFICE

v. Health Financing

• WHO provided technical support to cost the health sector right from the source of the 5-year Health Sector Development these resources, to the financing agents, Plan II (HSDP II) using the One Health to the providers of the services (health Tool and built capacity of MoH staff care providers) and ultimately to in the planning department on the the beneficiary population. This use of the tool. information is very central in planning and advocacy to enhance • As a member on the national the performance of the health system. taskforce, WHO participated in the development of the health financing • Developed a report on the transition and harmonization plan. This Institutionalization of National Health is critical as Uganda intensifies efforts to Accounts in Uganda which will increase domestic resources appropriated inform development of a guideline to to the health sector given the noted institutionalize the NHA for the AFRO declining trajectory of financial support region. from development partners. • Provided technical support to • Conducted the 8th cycle of the National comprehensive health sector budgeting Health Accounts (NHA) covering the FYs and planning which was very helpful in 2016/17, 2017/18 and 2018/19. The NHA advocating for an increased allocation is an essential exercise for evaluating and of the national budget to the health documenting a country’s health financing sector especially in light of the COVID-19 landscape. The NHA allows for policy pandemic. makers to track available resources in

A woman gets her blood pressure taken. PHOTO: WHO UGANDA Annual Report 2020 33

• With support from GAVI PEF, conducted a • Peer reviewed the costing and financing study to estimate the cost of introducing sections of National Deployment Vaccine TB vaccine booster doses. This information Plans for seven countries in the East and is very crucial in guiding the discussion on Southern African Region for the COVAX which new vaccines should be prioritized facility. This was a very key exercise to for introduction into the country. ensure that countries had accurately estimated the required resources for their • Performed an assessment of the Program plans to receive and administer vaccines Based Budgeting (PBB) Public Financial for COVID-19. Management (PFM) reform in Uganda with HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS) support from WHO/HQ. This assessment • Worked with other UN agencies to was very critical as the government of develop the UN Sustainable Development Uganda has officially transitioned from Cooperation Framework for 2020/21 – output-based budgeting to program 2024/25 and the UNSDCF joint workplans. based budgeting. The assessment will • Participated in the development of the be a reference document for the health UN Socio economic impact assessment sector during this transition. for COVID-19 report for Uganda. This • Participated in the performance review socio-economic impact assessment of the EPI program in Uganda including will guide efforts to address the socio- the coordination of the development economic challenges that resulted from of a costed muliti-year plan (cMYP) for the COVID-19 pandemic. the immunization program. The cMYP is an essential tool to guide planning and advocacy efforts for the immunization program.

vi. eHealth

• Deployed digital health innovations • WHO provided technical and financial such as GoData and ODK, to support support to the integration of ICD-II of COVID-19 response. These are open coding tool/module in DHIS2. Application Programming Interface (API) were source, online tools which integrated in Electronic Medical Record are used on desktops and (EMR) software (i.e. Integrated Intelligent mobile devices. The tools Computer Systems, IICS) and in the are gradually replacing the health management information system use of paper forms and have software (i.e. DHIS-2) in Uganda. Within enhanced data collection with the African region, Uganda is one of additional capabilities such as validation, the countries spearheading EMR and in turn improving preparedness and DHIS-2 deployment and the Ministry of Health is actively involved in ICD-11 response. implementation preparation. 34 WHO UGANDA COUNTRY OFFICE

vii. Human Resources for Health and Library Services

• Supported the Ministry of Health to write • Provided UN-Wellness services to staff the Human Resources for Health Strategic focusing on psychosocial counselling, Plan 2020-2030 engagement with staff association to ease access to services during the • Strengthened the resource COVID-19 pandemic and organising centres of three Regional Referral learning sessions for staff and Hospitals with books and other families to promote social interaction reading materials under the Book during lockdown. Aid Project.

CHALLENGES

• The advent of the COVID-19 pandemic • No real increases in health expenditure. resulted in change of focus and There is low and stagnant share of health prioritization of other planned activities. expenditure as a proportion of GDP. This affected implementation of planned • There are multiple arrangements for activities and achievement of results. pooling of resources, with overlaps arising • The pharmacovigilance program is in financing of the services leading to still suffering from low reporting rates. inefficiencies in resource pooling and Although there was an improvement, we management arrangements. continue to observe low reporting rates • The abrupt closure of the office due of adverse events resulting from use of to COVID-19 outbreak disrupted medical products by patients, and hence implementation of many health promotion hampering of detection of signals thresh activities across all programmes. While holds. the closure was necessary it however • Due to fear of the risk and poor slowed the office on programmes such as compliance to the government Standard malaria, tuberculosis, HIV/AIDS and NCDs Operating Procedures for prevention which require a lot of health promotion of COVID-19, physical meetings were support to effectively deliver services. disallowed thereby resorting to virtual • Health promotion continued to be engagements. This new way of working underfunded leading to dependency was not something majority of people on programmes for its interventions. were accustomed to thereby having Very often this approach compromises impact on speed of implementation of integration and synergy which health activities. promotion can promote given its cross- cutting nature. Annual Report 2020 35

• Inadequate health promotion technical • The pandemic and the ensuing change support affected implementation of in working modality have affected activities especially in the Ministry of the implementation of the 7th Uganda Health. This also slowed down WHO Demographic Health Survey (UDHS). The work as the available staff were either UDHS is a key source of data needed to overstretched or simply not available for monitor and evaluate population, health, the required collaboration. and nutrition programmes on a regular basis. By the end of 2020, the initial • The pandemic led to a general drop preparations which had started early in in the timeliness and completeness of HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS) the year, had not resumed. HMIS reporting, especially in the months following the lockdown.

LESSONS LEARNT

• Health system strengthening activities • It is critical for WHO to support should be cognizant of vulnerabilities and government develop health promotion purpose to make them resilient to effects structures especially the Community of disease outbreaks. Health Extension workers and the Village Health Teams because they are • Reporting of adverse events following indispensable during response to disease use of medical products may not improve outbreak as demonstrated during the given the demand of multiple reporting COVID-19 outbreak. requirements by health care workers in health facilities. • Deploying WHO supported staff or consultants in the field has a lot of public • Office work in various programs can still health benefits because they are able to continue even in the absence of face-to- support government and districts respond face meetings. This was well demonstrated to health issues in real time and are an with the work done on COVID-19 during invaluable resource to districts that have the national lockdown and subsequent dire human resource constraints. closure of the office. The challenge is in keeping participants effectively engaged • Regular documenting and sharing of and on building consensus. the contributions and best practices on WHO’s community work has tremendous potential to contribute to visibility and resource mobilization efforts of the office. 36 WHO UGANDA COUNTRY OFFICE

WAY FORWARD

• WCO will strengthen MoH leadership and • In health promotion and communication coordination role in the pharmaceutical WCO will strive to invest in virtual working sector, provide technical input to the modalities and technology, support development of government to invest in the development five year costed strategic plan, strengthen of community health structures (CHEWs the national pharmacovigilance system and VHTs) and to maintain presence in and promote appropriate use of medical regions and districts for visibility and quick products. Support will also be provided response to public health challenges. to improve reporting of safety on medical Regular documentation and sharing of products, governance of health products WHO best field practices in print, film and as well as promote best practices. photography will also be prioritized.

• In health financing, the WCO will support • Under analysis, use and access to Routine operationalization of the transition and facility data, WCO will assist MoH to harmonization plan for the health sector; finalize the Health Information and Digital development of resource mobilization Health strategy; strengthen the national strategies for disease specific and sector capacity to monitor and evaluate health wide programs; institutionalization of the sector performance; support integration National Health Accounts; and assessment of digital technologies into the health of the health financing strategies in system; development of interactive data Uganda using the WHO health financing visualization tools; and train clinicians on matrix. Other areas of focus will be ICD-11, verbal autopsy, classification of institutionalization for tracking financial risk protection indicators, conduct CoD and reporting. programmatic efficiency analysis for 5 health programs, and development of program specific investment cases. Annual Report 2020 37 HEALTH SYSTEMS STRENGTHENING CLUSTER (HSS)

Eating plenty of fruits and vegetables promotes good health. PHOTO: WHO UGANDA 38 WHO UGANDA COUNTRY OFFICE Annual Report 2020 39

3

DISEASE PREVENTION AND CONTROL (DPC) CLUSTER DISEASE PREVENTION AND CONTROL (DPC) CLUSTER

INTRODUCTION

The COVID-19 pandemic greatly affected implementation of activities across all WHO Country Office (WCO) clusters. The inevitable closure of the offices, restriction on movements, meetings interactions and the nation-wide local down halted implementation and hence the expected achievement of results. Despite the COVID-19 challenges, the WCO through the DPC cluster that A medical personnel is comprised of the Malaria, HIV, Hepatitis, and STIs; Tuberculosis; Neglected draws a blood sample to test for infections. Tropical Diseases; Non-Communicable Diseases; and Population Health and PHOTO: WHO UGANDA Environment programmes managed to make the following achievements. 40 WHO UGANDA COUNTRY OFFICE

Hon Minister of Health Dr Jane Ruth Aceng and WHO Dr Yonas Tegegn Woldemariam, at the launching ceremony of the UPFM Strategic Plan. PHOTO: WHO UGANDA

ACHIEVEMENTS i. Policies, Strategies and Guidelines

• Supported the development, adaptation the Uganda Malaria Reduction Strategic and dissemination of several plans, Plan (UMRSP) 2014-2020, including strategies, tools, manuals, and SOPs for a comprehensive malaria programme disease prevention and control. review whose findings were used to These include National develop the new generation malaria Strategic Plan (NSP) for reduction and elimination strategic plan TB for 2020/21-2024/25; (UMRESP) 2021-2025. the National Multisectoral • Facilitated the adaptation of Accountability Framework for WHO recommendation into service TB (MAF-TB); the National HIV/AIDS tools and packages. Technical guidance Strategic Plan 2021/2022-2025/2026; was provided to MoH (AIDS Control the Tobacco control strategic plan 2021- Programme) and its partners to adapt 2025; the Mental Health strategic plan the new ART recommendations into the 2020/2025; and the draft National Cancer revised National Consolidated Guidelines Control plan 2020/2025. for HIV prevention and treatment which • Supported the Ministry of Health (MoH) were launched and rolled-out at regional to conduct the end term evaluation of and district level. Annual Report 2020 41

• Contributed to the drafting of the HIV • WHO supported the MoH to develop self-testing scale-up plan and training guidelines for effective deployment of curriculum that are key guidance tools indoor residual spraying (IRS) during for the country scale up in both the public COVID-19 protecting over 4.9 million and private sectors. people.

• Provided technical guidance towards • WHO, in collaboration with MoH/Neglected the drafting of the Tobacco Control Tropical Diseases (NTD) Program and Act Communication Strategy 2021-2025. to End NTDs East, developed the Uganda Sustainability Plan for Neglected Tropical Diseases Control Program 2020–2025.

ii. Partnerships and Multisectoral action

• Continued to support the AIDS the malaria and COVID-19 coordination Development Partners Group (ADPG), meeting, Joint High Burden High Impact Joint UN team on HIV/AIDS (JUPSA), (HBHI) briefings with AFRO and WHO HQ, Multisectoral HIV/AIDS Partnership thematic working groups resulting into

forum of the UAC to steer the proper guidance, development of tools DISEASE PREVENTION AND CONTROL (DPC) CLUSTER health sector agenda within the on the observed COVID-19 SoPs and HIV response and facilitated the continuation of essential services in CCM as an ex-officio member. malaria including IRS, distribution of mosquito nets, treatment of cases • Provided technical support during at community and health facilities and the writing process of the Global Fund Social Behaviour Change Communication concept notes that were approved and messages. this attracted 34 million USD to support the control of and limit effects due to • Worked with the United Nations Inter- COVID-19. Agency Task Force on NCDs (UNIATF) to write the NCD Investment Case report for • Supported the formation of the “Malaria Uganda as a resource mobilization tool Free Uganda” cooperation led by for driving the NCD agenda in the country. Rotarians, and endorsed by the Office of the Prime Minister and MoH and whose • Supported the MoH and the National main objective is to mobilize additional Medical Stores (NMS) to quantify the resources for malaria control from the insulin requirement gap following private sector. selection of Uganda by AFRO as one of the recipients of a donation from Norvatis. • Engaged malaria partnership and The insulin donation of over 10,000 doses stakeholders via virtual meetings such as was received by NMS. 42 WHO UGANDA COUNTRY OFFICE

The Minister of Health Dr Jane Ruth Aceng flagging off field survey teams for the Uganda Population Based HIV-Impact Assessment. PHOTO: WHO UGANDA

• Supported the ‘’Purple Bench Initiative’’, Cancer Society during commemoration of an NGO working on Creating awareness World Cancer Day 2020. and advocacy for Epilepsy to write the • WHO collaborated with NTDs partners technical report on commemoration of and several NTD Disease-specific Expert the World Epilepsy Day 2020. Groups including Uganda Onchocerciasis • Facilitated the Uganda Insurers Elimination Expert Group to review the Association and Ministry of Health to progress and recommend way forward in organise the World Day of Remembrance 2020. of Road Accident Victims and the Uganda

iii. Capacity building

• Continued to support MoH (National contributed to the continuity of services Malaria Control Division) through full amidst the unprecedented time placement of three technical officers interruptions due to COVID-19. in three key strategic areas of partnerships • Quarterly NTD Coordination and multi-sectoral collaborations, policy and Partnership meetings and strategy and malaria epidemiology. were organized by NTD/VCD Their presence in the malaria programme and facilitated by WHO. Annual Report 2020 43

iv. Service Delivery

• Supported the MoH to develop guidelines waves 1- 5b of the universal coverage for effective deployment of Indoor Residual campaign targeting members of a Spraying (IRS) and Long Lasting household at a ratio of 1 net for every two Insecticide Treated Nets (LLINs) persons reaching an administrative distribution during COVID-19. coverage of approximately 90%. In During IRS spray Phase II in May addition, mosquito nets were given 25 – June 20 (COVID-19 Lock to market venders who were sleeping down period), 650,000 structures at their stalls because of the lock down were sprayed protecting a population of measures, to flooded areas of Kyotera, over 1.8m people. Over 26 Million LLINs Kasese and other districts neighbouring were distributed countrywide during Lake Kyoga. Proportion malaria suspected that received a test Figure 4: Proportion of Malaria suspected cases that received a test DISEASE PREVENTION AND CONTROL (DPC) CLUSTER

Percentage of confirmed malaria cases treated with artemisinin-based Figure 5: Percentage of confirmed malariaco casesmb treatedinat iowithn Artemisinin-basedtherapies Combination therapies

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44 WHO UGANDA COUNTRY OFFICE

• Facilitated the district led programming supervision of delivery of TB and Leprosy strategy in the scale up of safe male services. The orientation was conducted circumcision in Karamoja Region through through a three-day online workshop. the Procurement of SMC supplies and Topics covered included strategies for TB commodities that included; anesthetics, case finding at community and facility syringes/needles, 2400 disposable kits and level, laboratory methods for TB diagnosis, monitoring and evaluation of TB and 200 re-usable kits, surgical pants, aprons, Leprosy services, and the National TB mackintosh, analgesics, gauze and cotton and Leprosy Strategic Plan for 2020/21- wool which were utilized during the SMC 2024/25. campaigns in two districts. • Supported MoH/NTLP to develop, • Supported the National TB and Leprosy implement, and monitor guidelines for Program (NTLP) to orient District Health recovery and continuity of TB services. Authorities (District Health Officers and The implementation of the guidelines District Medical Officers) on TB and resulted in a quick recovery of the TB Leprosy. The District Health Authorities services in 2020. However, service delivery were targeted for the orientation because has remained sub-optimal as indicated in of their critical role in leadership and the chart below.

Figure 6: TB Case finding against target

T 1800

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Annual Report 2020 45 DISEASE PREVENTION AND CONTROL (DPC) CLUSTER

A WHO staff teaching health workers how to wear and remove Personal Protective Equipment. PHOTO: WHO UGANDA

• Played a pivotal role towards organizing operational guidelines in the context of the third virtual National TB Conference. of COVID-19 response for larval source The objectives of the TB conference were management at vector breeding sites to provide an account about TB in Uganda around markets in many Uganda urban and to launch the five-year National TB settings. Strategic Plan for 2020-2025 and the • WHO continued to be the lead partner Multisectoral Accountability Framework for TB. Over 300 delegates attended the in procurement and supply chain conference via zoom online platform. The management of NTD diagnostics and TB conference was held jointly with the medicines and supplies at country level, 26th Health Sector Joint Review Mission. in collaboration with Expanded Special Project on Elimination of NTDs (ESPEN), • WHO provided advocacy support to MoH shared estimates commodity data and and specific technical guidance to adapt managed receipt on behalf of Uganda. 46 WHO UGANDA COUNTRY OFFICE

v. Data generation and strategic information

• Conducted several evaluations, reviews, guide capacity development efforts and support supervisions under Strategic for the Uganda Malaria Reduction and Priority 3 on sustaining focus on Elimination Strategic Plan (UMRESP) health-related SDGs in line with WHO’s implementation. information function. • Technical and financial support were • Provided technical support to MoH and provided to the CARAMAL Project to partners towards the finalization of the study the community access for pre- National and District level 2020 targets referral treatment of severe malaria using of core public health HIV/AIDS services for rectal artesunate suppositories in Apac, the HIV epidemic control in Uganda. The Kwania, Kole and Oyam districts. Evidence targets generated are intended to ease generated and best practices informed the monitoring of service coverage use of the drug in Integrated Community including attainment of the Case Management (ICCM). Rectal 2020 targets at National and artesunate suppositories have been sub-national level with the included in the essential medicines list aim of attaining sustainable of Uganda and in the formal Procurement HIV epidemic control. Supply Management (PSM) system of the MoH. • Facilitated the generation of the 2019 HIV epidemiological surveillance report for • WHO continued to support MoH to Uganda through technical guidance. The produce the weekly, monthly and quarterly report provides a synthesis of the recent malaria bulletins. epidemiological data on the magnitude • The Open Electronic Medical Records and dynamics of the HIV epidemic in system EMRs for tracking HIV patients Uganda in the recent years. It further in Karamoja Region was supported highlights the significant gains made technically and financially enabling 17 during the past decade towards epidemic health facilities to access EMRs. Key to control. note was that 53% of the health facilities • To generate evidence to further strengthen had installed Uganda EMRs for data the NMCP and strategize for effective capture. However, 42% of health facilities roll-out and implementation of the supported had no computer to host EMRs malaria strategic plan, WHO supported and 72% had erratic internet access. assessments on the adequacy and • The WCO provided technical input into appropriateness of technical assistance the design of an electronic case-based provided by partners to MoH and on surveillance of TB (eCBSS) which will be training needs. In addition, a Technical implemented at facility-level. Technical Needs Assessment was conducted to support was provided for the following: Annual Report 2020 47

(1) preparation of the scope of work for benchmarks necessary for the eCBSS. The developing the eCBSS; (2) articulation system is currently being rolled-out at fifty of the TB care pathways; (3) Stakeholder (50) health facilities. engagement; and (4) WHO standards and

Figure 7: Envisaged architecture of the eCBSS for TB and the Data model for TB via DHIS2 DISEASE PREVENTION AND CONTROL (DPC) CLUSTER

• WCO supported NTLP to develop a facility and communities; (4) consolidate protocol for the 2nd DR-TB survey. The and disseminate risk communication protocol was submitted to WHO/AFRO materials during the response period; (5) to mobilize the required funds (400,000 enhance use of data for disease control at USD) that will, among other issues help all levels, including community reporting; determine estimates of drug-resistant TB and (6) improve screening for rifampicin in Uganda. The last DR-TB survey was resistance for identified bacteriologically conducted over 10 years ago. confirmed TB patients to 100%.

• WHO led the Evaluation and mid-review • In collaboration with the Ministry of of the TB emergency response that sought Health and partners WCO coordinated to: (1) Activate the national TB emergency data collection and validation for the response at the national and district Mental Health Atlas. level; (2) achieve >90% retention of all • During the COVID-19 outbreak, WHO TB patients initiated on treatment; (3) coordinated data collection on Mental conduct active TB case finding in the health Health to establish the Mental Health 48 WHO UGANDA COUNTRY OFFICE

service gaps and needs of the affected • WHO facilitated the analysis of HMIS data persons that informed WHO about the comparing similar periods of 2019 and needed support. 2020 to assess the effect of COVID-19 on continuity of Essential services for NCDs. • WCO coordinated data collection for the national cervical cancer management • Figure 8 and 9 indicate a general increase in non-communicable diseases cases capacity survey 2020. The findings of attended to at health facilities. However the survey will inform the response plan for the same period in 2020 there was for elimination of cancer of the cervix by a sharp decline in cases associated with 2030. This is a follow-up action on the COVID-19 pandemic. This presentation WHO Director General’s call to Member will be made at the CEHS pillar meeting to States to eliminate cancer of the cervix as advocate for additional resources for non- a public health problem by 2030. communicable diseases service delivery.

Figure 8: Uptake of Noncommunicable diseases services from Jan to May 2019

T NCD 60000 50000 40000 30000 20000 10000 0 Jan-19 Feb-19 Mar-19 Apr-19 May-19

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Figure 9: Uptake of Noncommunicable diseases services from Jan to May 2020

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Annual Report 2020 49

• In the context of COVID-19 response, WHO coordinated several online surveys to assess impact of COVID-19 pandemic on NTD programming that informed adaptation of generic WHO tools.

• WHO contributed national data to global WHO reports on several NTDs including Visceral Leishmaniasis (VL), Trachoma, Schistosomiasis and Guinea worm.

Blood samples ready for testing. PHOTO: WHO UGANDA DISEASE PREVENTION AND CONTROL (DPC) CLUSTER 50 WHO UGANDA COUNTRY OFFICE

vi. Resource Mobilization

• WCO participated in the drafting of the which was approved by WHO Regional Global Fund for TB, AIDS and Malaria Office and Headquarters. Concept notes which were approved to • Technical support of the country office fund the three diseases including Health to Ministry of Health was critical in Systems Strengthening. mobilizing USD 20,000 to strengthen • WHO supported MoH to advocate for implementation of WHO Package of increased domestic resources for malaria Essential Non-communicable disease in addition to technical assistance to interventions (WHO-PEN) in 7 districts in develop and disseminate guidelines on central and eastern Uganda. The proposal this issue. As a result, it was agreed that was approved by AFRO and USD 50,000 malaria should be mainstreamed in all from WHO/HQ Cervical Cancer Elimination ministries, departments, and agencies Initiative was advanced to implement (MDAs) including districts. The Permanent planned activities. Secretary and Secretary to the Treasury • WCO estimated the insulin requirement sent a circular to all sectors instructing gap for Uganda in collaboration with them to mainstream malaria into their National Medical Stores and the Ministry budgets. of Health. Based on the quantification, • WCO supported MoH to develop the Uganda received 13,000 vials of insulin food procurement policy, food labelling (protaphane, actrapid and mixtard) standards and nutrition guidelines that equivalent to 1,300,000 doses from attracted USD 75,000. Uganda is one of Novartis, a Danish Pharmaceutical the three countries globally that qualified Company through the WHO Regional for the one -time grant from Resolve to Office. Uganda also received equipment Save Lives. WHO played a key role in worth USD 15,282 to strengthen NCD drafting a proposal on management of services. hypertension worth USD 200,000. The • WHO mobilized and contributed proposal submitted to Resolve to Save USD10,000 towards the implementation Lives is under review. of capacity building and support • WHO supported MoH to write the supervision of Visceral Leishmaniasis (VL) proposal for the second NCD Steps Risk in of Uganda. Factor Survey worth about USD 500,000 Annual Report 2020 51

vii. COVID-19 response related activities

• The DPC Cluster members supported Health and Psychosocial support. Various the office COVID-19 response through service packages and guidelines to coordination of the following pillars: support the response were developed Field coordination; Continuity of Essential and disseminated through the technical Health Services, Points of Entry, Mental support function of the WCO.

CHALLENGES

• The national lock down and travel • Lack of quality data hinders advocacy restrictions due to COVID-19 pandemic efforts for prioritizing NCDs on the affected service delivery for both national agenda. Insufficient investment DISEASE PREVENTION AND CONTROL (DPC) CLUSTER Communicable and Non-communicable in prevention and management of diseases. Operations particularly those non-communicable diseases by the that required community engagement, government is a huge obstacle and yet trainings, mentorships and dialogues partner funding is inadequate. were greatly affected. However, this • Inadequate awareness about NCD and was quickly mitigated by supporting the risk factors by the population leading to continuation of essential services pillar late presentation with complications and and the development the CEHS guidelines high NCD mortality. With the current level that enabled resumption of service of investment, the country is unlikely to delivery while observing the COVID-19 achieve the global targets of reducing SoPs. premature mortality by 25% by 2025 and • Access to quality care for non- SDG target of one-third by 2030. communicable diseases remains an • Planned Midterm Review (MTR) of obstacle for Universal Health Coverage the Uganda Master Plan of Action on because of irregular access to essential NTDs 2017-2020 scheduled for 2020 medicines and basic technologies, was disrupted by COVID-19 pandemic inadequate health care workers among and response interventions including others. lockdown. 52 WHO UGANDA COUNTRY OFFICE

LESSONS LEARNT

• 2020 remains a special year of COVID-19 • High burden High impact and mass action pandemic with significant disruptions against malaria approaches are very in socio-economic activities including important initiatives where everyone’s health. However, the response to the contribution in disease prevention and pandemic presented a golden opportunity management, at all levels is important to develop coping mechanisms to the particularly the political level, multisector/ new normal including maximizing virtual private sector, the community, and capacity building, coordination, and households. integrated programming opportunities.

WAY FORWARD

• Under communicable diseases, the cluster will focus on development and finalization of vital tools, guidelines, strategies and plans as well undertake programme reviews, studies, advocacy, partner dialogues and resource mobilization activities.

• For NCDs, the cluster will advocate for increased government and partner investment, dissemination of prevention and control measures, laws and regulations, generation of evidence and resource mobilization.

• WHO will continue to build on the lessons learned during the COVID-19 pandemic response season maximizing integrated programing opportunities. Annual Report 2020 53 DISEASE PREVENTION AND CONTROL (DPC) CLUSTER

Health workers in a COVID-19 testing laboratory. PHOTO: WHO UGANDA 54 WHO UGANDA COUNTRY OFFICE Annual Report 2020 55

4

IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER

INTRODUCTION IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER The year 2020 marked the end of decade of vaccines which had the vision of having all individuals and communities enjoy lives free from vaccine preventable diseases. The same year was also used to develop the immunization agenda 2030 through virtual consultations with all stakeholders amidst the challenges of the Coronavirus Disease (COVID-19). Due to the COVID-19 pandemic there was disruption of routine immunization activities due to decreased demand for vaccination because of social distancing requirements and community reluctance to seek services. However, several efforts and technical guidance documents A health worker immunizing a were developed to support countries resume provision of routine immunization newly born baby against polio. services and supplementary immunization activities in a safe environment by PHOTO: WHO UGANDA protecting both the health workers and communities. 56 WHO UGANDA COUNTRY OFFICE

In line with GPW13 targets under outcome one, the cluster addressed population-specific health needs and barriers to equity across the life course. This chapter highlights the WHO Country Office’s (WCO) achievements made in 2020, a globally challenging year.

ACHIEVEMENTS

i. Maternal and New-born Health

• Supported the MoH to implement Phase two of the Maternal and Newborn Quality of Care by orienting 64 national Quality Improvement Facilitators and 40 district health teams on Point of Care Quality Improvement.

• Provided technical oversight during the development of the Ministry of Health Point of Care Quality Improvement (PoCQI) training mentorship tool and Trainer of Trainees as well as joint site mentorship in .

• Provided technical guidance during the establishment of the MoH Antenatal Care subcommittee that met eight times in the year to resolve issues related to finalization of the training materials for health workers on ANC and the design of the Goal Oriented ANC protocol. At the same time, WHO initiated the country processes to adapt the WHO 2016 ANC guidelines.

• Disseminated the adapted WHO 2016 guidelines through a webinar to over 65 participants in eight districts focusing on better pregnancy and birth outcomes.

• To fast-track implementation of the Maternal New Health Quality of Care (MNH QoC) the WCO organized and engaged the district health leaderships of the six MNH QoC learning districts in monthly virtual calls during which each district team presented their MNH QoC implementation progress and thereafter developed district specific action plans.

• Supported the MoH to build capacity of 55 Maternal Child Health providers from on the application of the Point of Care Quality Improvement (PoCQI) in their routine MNCH work in late August 2020. It was piloted during the training in Humanitarian Health in Bidi Bidi HC III in . Annual Report 2020 57

• Supported adaptation of the global MNH QoC common core indicators into the District Health Information Software 2 (DHIS2) in six districts.

• Supported the development of Community Engagement guidelines to improve MNH quality of care.

• Provided technical support to develop and print the MoH Post- Partum hemorrhage (PPH) Prevention and Control strategy.

• Supported the finalization and submission of the Strengthening Health Systems for MCH project documents to Korea International Cooperation Agency (KOICA) that provided funding for the 5-year project.

• Provided technical support to the Rotary International team to develop the WHO/Rotary proposal for a MCH project that will be implemented in Kabale, Kanungu, and Wakiso districts.

• Provided technical guidance to School of Public Health (Mak-SPH) to develop and customize the WHO MNH QoC assessment tools, piloting the tools and training the assessors including report writing.

• Supported the writing and printing of the Maternal and Perinatal Death surveillance Report FY2018/2019 and distributed 1000 copies to eight districts.

A nurse attending to neonates at Hoima Regional Referral Hospital. PHOTO: WHO UGANDA IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER 58 WHO UGANDA COUNTRY OFFICE

A young mother and her child. PHOTO: WHO UGANDA ii. Reproductive Health

• Supported the drafting of the Male Involvement Training Manual, Mid-term review report for the Mainstreaming Gender and Rights in the ongoing implementation of Health Sector, Essential Maternal and the 2gether4 SRHR/HIV /GBV Newborn Care Guidelines, Immunization project being implemented Flip Chart, and the Postpartum Family by UNICEF, UNFPA, UNAIDS and Planning Flip Chart. WHO. • Initiated partnership with Federal Republic • Supported the printing of the training of Nigeria to learn and share experiences, materials to be used for capacity challenges, and good practices on using building in the eight districts. These the human rights-based approach to materials included Quality Improvement improving quality of care in family in Emergency Obstetric care Leadership planning. Six monthly virtual meetings Manual, Family Planning Training Manual, were held and a road map developed to Comprehensive Abortion Care Curriculum, implement this initiative. Annual Report 2020 59

iii. Child Health

• Supported the revision of the Integrated community case management National guidelines on the of Diarrhoea, Pneumonia and Malaria by Integrated management the Village Health Teams (VHTs). The VHT of Childhood Illnesses to job aids were also revised to reflect the incorporate the global additional role that they are expected to guidance developed by WHO play in PSBI implementation. regarding outpatient of newborn babies with Possible Serious Bacterial • Supported the initial technical discussions Infection (PSBI) where referral is not to revise the child survival strategy for possible. Uganda. The new child health strategy has been informed by and incorporated • Provided technical support to revise the current proposal child health redesign the implementation guidelines for the that is going on at global level.

Figure 10: Integrated Management of Childhood Illnesses (IMCI) chart booklet. IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER 60 WHO UGANDA COUNTRY OFFICE

A nurse immunises a woman at Masaka National Hospital during a medical camp. PHOTO: WHO UGANDA

iv. Adolescent Health

• Facilitated the drafting of the National • Supported the development of the Adolescent Health Strategy to be adolescent health service standards and provided technical support to finalized by the MoH followed Muslim Hospital to initiate adolescent by developing a costed plan. friendly services beginning with the maternal health services component.

v. Nutrition

• Supported the ministry of health to • Supported coordination between the core establish the National Steering Committee staff from National Information Platforms for the European Commission-supported for Nutrition (NIPN) and the Nutrition Nutrition Information Project that is aimed Information System project through at strengthening the use of HMIS routinely organization of meetings, in generated nutrition data in planning. The consultation with the MoH steering committee approved the project Nutrition Technical Working annual workplan and will meet semi- Group. annually to steer the project over the next four years. Annual Report 2020 61

vi. Gender/GBV

• Supported Makerere University School • Participated in the quarterly Sexual of Public Health to review Pre-Service Reproductive & Human Rights (SRHR) training curricula for Sexual Gender Based Donor working group meetings in which Vaccine/Violence Against Children (SGBV/ the Male Involvement Strategy was VAC)/Maternal Newborn Health Quality presented to the UN team for consultation. of Care aimed at ensuring that health • Participated in the Prevention of workers are competent in the provision Sexual Exploitation and Abuse (PSEA) of SGBV/VAC including quality Maternal Coordination working group in which Newborn Health services after guidelines for use by the frontline responders and field staff were pre-service training and are fit developed, printed, and disseminated to for purpose during in service. various NGOs. Government officers and • Participated in the UN Gender UN staff will subsequently be trained on and Human Rights working these materials. group meetings while highlighting • Facilitated the establishment of the the role of WHO as well as offering the Male Involvement working group at the needed support. Ministry of Health now chaired by the Commissioner for Health Promotion and Education.

A nurse preparing to immunise a baby in a clinic at Masaka National Hospital. PHOTO: WHO UGANDA IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER 62 WHO UGANDA COUNTRY OFFICE

vii. Polio eradication

• Supported MoH (Uganda National • Supported four STOP missions in fifty (50) Expanded Programme on Immunization) districts where Nine hundred and fifty- to implement AFP surveillance activities three (953) health facilities of various as a way of documenting progress from categories were supported, and twenty- eradication to elimination of the Wild two (22) heavily populated communities Poliovirus (WPV) transmission in the visited to strengthen AFP surveillance country within the Integrated Disease within IDSR framework using Open Data Surveillance and Response (IDSR) Kit (ODK). framework.

Figure 11: Non Polio AFP Rate as at week 52 by Districts, 2020

Annual Report 2020 63

Figure 12: Stool Adequacy Rate at Week 52 by Districts, 2020

• Mentored 3,127 health workers and 5405 • Supported the MoH to collect sewage community members including influential samples from six sites in four districts an leaders and 1187 VHTs on surveillance, increase from the four sites in two districts IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER cold chain management and routine the previous year. All the four (4) sites are functioning well and are collecting immunization. samples monthly. The system is • Supported detection and sensitive as evidenced by isolation of investigation of 127 AFP cases Sabin, Non Polio Enterovirus (NPEV) country wide. Consequently, the and NEV. national level NPAFP rate for January to December 2020 was 2.01 while stool adequacy rate was 91% - both above the required targets of 2 and 80% respectively. 64 WHO UGANDA COUNTRY OFFICE

• Supported functionality of the National National Polio Expert Committee (NPEC) Polio Committee that held 23 meetings conducted field visits to 15 districts and reviewed 2,019 annual progress report where 38 AFP cases were classified. In on certification drafted by the secretariat addition, The National Task Force (NTF) before submission to the African Regional assessed the Biosafety Level (BL) practice Certification Commission (ARCC). in 20 laboratories in 5 districts as well as • Supported the review, certification, internal validation of 73 laboratories and and containment of 450 AFP cases. The research stations.

Figure 13: Uganda ES samples processed in the laboratory by month and site from February 2020 to January 2021

Site Name Site code Uganda ES samples processed in the lab by month and site from February 2020 to Janaury 2021 Kampala, Wakiso, Kabarole Arua-Epidemiological Week 2020/2021 Kampala, Wakiso, Kabarole and Arua Code Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Bugolobi sewerage plant BUG 5 5 7 5 3 7 6 3 5 3 5 15 sewerage plant LUB 5 5 5 7 6 5 5 5 5 7 7 15

Ministry of Internal affairs MOI 3 5 5 7 5 5 5 3 5 5 5 15

Kitooro sewerage plant KTR 3 5 6 5 5 7 5 5 5 7 5 6

Kisenyi sewage ponds KIS 5 3 3 3 5 5

Prison Cell Sewage Treatment Plant PRC 5 6 5 5 6 5

1 Not scheduled 6 S abin 11 WPV1+cVDPV2 16 NEV + NPEV

2 Pending 7 NPENT + Sabin 12 Sent for sequencing 17 NEV + S abi n

3 Negative 8 cVDPV2 13 Scheduled but not collected

4 NEV 9 WPV1 14 S abin 2

5 NPENT 10 WPV3 15 S abi n + NPEV + NEV

viii. Measles and rubella surveillance

• Supported MoH to implement measles supported to detect and investigate surveillance activities to prevent or limit suspected measles outbreaks within the secondary transmission. Overall, 412 required 48 hours of detecting the index suspected measles cases were detected case. and investigated. Sixteen districts were Annual Report 2020 65

ix. Use of new and underutilized vaccines

• Worked with MoH to implement the • In addition, Moroto district was supported National Cholera strategic plan 2017/18 to conduct a reactive campaign of OCV – 2021/22. The third phase of pre-emptive in Nadunget, Rupa, South Division, Oral Cholera Vaccine (OCV) campaign North Division and Katikekile sub in Namayingo, Madi-Okollo, counties. Of the 94,954 eligible Obongi, Kasese and Ntoroko persons 74,023 (78%) received districts - a total of 41 hotspots their first dose while 65,219 (88%) (sub counties) were covered. A received their second dose. For both total of 950,522 persons aged above campaigns COVID-19 guidelines and one year out of the targetted 1,073,061 Standard Operating Procedures (SoPs) received their first dose of OCV giving a were strictly followed. coverage of 89%.

Figure 14: Oral Cholera Vaccination campaigns conducted in 2020 Oral Cholera Vaccination campaigns conducted in 2020

98% 97% 99% 100% 90% 86% 90% 82% 85% 80% 74% 70% 60% 50% 40%

30% IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER 20% 10% 0%

Busia Moroto Kasese Ntoroko Obongi Namayingo Madi-Okollo OCV Dose 1 OCV dose 2

66 WHO UGANDA COUNTRY OFFICE

• Supported MoH to conduct a reactive yellow fever campaign in five high risk districts (Maracha, Koboko, Yumbe, Moyo, Obongi and Buliisa) among persons aged 9 months to under 60 years of age. A total of 1,773,795(109%) of the target population of 1,629,573 were offered protection against yellow fever infection.

Figure 15: Yellow Fever Coverage Campaign Results 24th to 30th August 2020

Yellow Fever Campaign Results August 24th – 30th 2020 #(and%) of sub- No. No. No. Admin counties AEFI District Target Age Target Pop Serious Reached Coverage with >95% attributed AEFI admin coverage to SIA Maracha 9m to < 60 years 193,719 212,437 110% 8/8 (100%) 7 1 Koboko 9m to < 60 years 239,940 249,103 104% 6/9 (67%) 18 3 Yumbe 9m to < 60 years 798,835 897,026 112% 13/13 (100%) 30 4 Moyo 9m to < 60 years 101,835 89,624 88% 3/7(43%) 2 1 Obongi 9m to < 60 years 162,719 194,662 120% 5/9 (565) 3 2 Buliisa 9m to < 60 years 132,525 130,943 99% 6/8 (75%) 4 0 Overall 9m to < 60 years 1,629,573 1,773,795 109% 41/47 (87%) 64 11

• Continued to support and coordinate three rotavirus surveillance sentinel sites i.e. Mulago National Referral Hospital, Hospital and Naguru China Friendship Hospital. Two invasive bacterial vaccine-preventable diseases surveillance sentinel sites: Mulago National Referral Hospital and St. Mary’s Hospital Lacor continued operations as well. There is a clear reduction in the number of laboratory confirmed HIB, Rotavirus and Streptococuss pneumonia cases since the introduction of Penta Valent, PCV10 and Rotavirus vaccines into routine immunization program. Annual Report 2020 67

• Closely collaborated with Centers for Disease Control (CDC) to conduct a cost study on the introduction of three boosters doses of DTPCV vaccine into routine immunization program. It was found that overall, after the introduction of the 3 booster doses, an estimated cost of UGX 9.7 billion ($2.6 million) and UGX 15.2 billion ($4.1 million) will be the economic cost per year for providing booster doses of DTPV at fixed health facilities and outreaches including schools.

Figure 16: Impact of Hib, Rotavirus vaccine and PCV on disease burden in under five. Source: New vaccine sentinel surveillance data, 2015 to 2020

500 450 436 400 350 300 250 225 235 200 No of cases No of 145 150 100 58 39 50 20 0 13 12 3 9 2 3 0 2 2 2 0 2015 2016 2017 2018 2019 2020 Year

Rotavirus positive HIB Positive IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER Strept Pneumococcal positive Linear (Rotavirus positive)

68 WHO UGANDA COUNTRY OFFICE

x. Country Ownership of Immunization Program

• Continued to support the Uganda National Immunization Technical Advisory Group to ensure that country policy recommendations related to immunization program are provided. During the review period, a working group for COVID-19 vaccine was established. A policy brief on introduction of the second dose of IPV and an amended recommendation to introduce birth dose of hepatitis B was developed and shared with MoH.

xi. Monitoring

• Supported MoH to conduct an integrated Expanded Program on immunization (EPI) review that focused on assessment of the strengths and weaknesses of an immunization Programme at national, sub-national, and service- delivery levels and post validation maternal and neonatal tetanus elimination. Findings will feed into the next Multi Five Year Country Plan (cMYP).

• Supported MoH to conduct an operational research to determine the barriers to routine immunization. The findings will feed into the next cMYP.

xii. Resource mobilization

• Supported MoH to develop resource mobilization strategy and plan that has contributed to an increase in Government of Uganda’s contribution by 100% in 2019/2020 and 2020/2021 financial years towards vaccines and operations.

xiii. Capacity building

• Supported MoH to conduct in service training on vaccine pharmacovigilance (Adverse Events Following Immunization surveillance) in 44 districts drawn from 2,719 health facilities where a total of 5,607 health workers’ skills and knowledge on how to detect and report an AEFI were enhanced. Annual Report 2020 69

• Supported the MoH to implement strategies to reduce on Missed Opportunities of Vaccination (MOV), following the national MOV assessment conducted in 2019 found that MOV was at 60% in Uganda. A pool of 30 national experts on MOV was established while 1,596 health facilities drawn from 54 districts were targeted to address MOV within their catchment areas.

xiv. COVID-19 19 response related activities

• During 2020, Cluster members were repurposed to strengthen the WCO capacity to respond to the COVID-19 outbreak. They supported case management, Mental Health Psychosocial Support (MHPSS), coordination, and surveillance among other related responsibilities.

CHALLENGES

• The prolonged processes at the district • Slow progress regarding health of older level to access funds greatly affected the person’s strategic direction due to poor quality of the campaigns given that health financial support to the Ministry of Health workers were note paid immediately or as team.

soon as possible. IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER • Inadequate prioritization and funding • Resources were inadequate to expand the for gender, equality, and rights related scope of work for planned activities. activities

• Slow progress in routine collection of • COVID-19 restrictions on travel, meeting RMNCAH data using online templates and other gatherings which impacted provided by WHO/AFRO . implementation of activities especially at district level. 70 WHO UGANDA COUNTRY OFFICE

LESSONS LEARNT

• Establishment and collaboration with • Tele-consultation and counselling by stakeholders to support WHO deliver its frontline ANC providers introduced home mandate greatly enables the WCO achieve visits and reduced exposure of pregnant at least 80% of the planned activities. to COVID-19 Pandemic.

• The MOV strategy is a major landmark in • Domestic violence of all types increased QI and EPI coverage at health facilities during COVID-19 isolation and lockdown. and in districts. Children, girls, women, and people with • Vaccination is an integral part of health disabilities were especially vulnerable system including service delivery and necessitating NGOs and CSOs to work cannot be implemented as evidenced from closely with the MoH to take services to the implantation of the MOV strategy. communities.

• Virtual engagements eased implementation • Adolescent boys and girls were more of planned capacity building efforts and vulnerable to anxiety, stress, and health- are more cost-effective despite internet risk behaviours, during isolation and the challenges at the sub national level. prolonged lockdown necessitating special • Prioritizing high risk pregnancies for ANC programs to fill gaps in the education by giving mothers specific appointments system. This brought on board youth enabled health workers and health serving organizations to work more facilities to reduce overcrowding and closely to take services to fellow young maintain physical distancing as required people. by the COVID-19 guidelines and SoPs.

WAY FORWARD

• The cluster will work with and support interventions throughout the country MoH to implement the national but especially in the KOICA supported immunization plan, conduct special districts. immunization campaigns, introduction • Documentation and sharing of best of new vaccines, and roll-out of the practices and case studies will be done COVID-19 vaccine. for all programmes under this cluster • More attention and focus will aimed at improved service delivery, be put on support to maternal, fund raising and eventually better neonatal, childhood and adolescent health indicators. Annual Report 2020 71

A nurse attends to a mother who had just delivered a baby. PHOTO: WHO UGANDA IMMUNIZATION VACCINE DEVELOPMENT FAMILY AND REPRODUCTIVE HEALTH (IVD/FRH) CLUSTER 72 WHO UGANDA COUNTRY OFFICE Annual Report 2020

73 WHO COUNTRY SUPPORT CLUSTER (CSU)

5

WHO COUNTRY SUPPORT CLUSTER (CSU)

INTRODUCTION

The Country Support Unit (CSU) provides operational support to Programme implementation in terms of financial management, Human Resources, Information Management and Communication (ICT), Logistics, and Compliance and Risk Management. In 2020 the CSU Cluster achieved the following results:

ACHIEVEMENTS

i. Programme Management and Support Motorcycles ready for dispatch to • The country office biennial workplan 2020/21 is currently funded at support community response to USD 20,993,240 (2020 funding net of carry forwards) compared to COVID-19.

PHOTO: WHO UGANDA USD 34,960,789 for the entire biennium 2018/19. 74 WHO UGANDA COUNTRY OFFICE

• Out of the current funding, 25% is from Voluntary Contributions Specific (VCS), 52% for Outbreak and Crisis Response (OCR), 10% for Assessed Contributions (AC) 6% from Specialised Programs and Collaborative Arrangements (SPA), and 7% from Programme Support (PS) and Voluntary Contributions Core (VCC).

1,013,660 : 5% AC

343,621 : 2% OCR

1,326,261 : 6% VCC

5,303,681 : 25% PS

2,052,099 : 10% SPA

10,953,918 : 52% VCS

Figure 17: 2020 contributions to country office workplan by fund type

• During the year 2020, the country office mobilized financial resources locally amounting USD 8,131,519 (excluding PSC) compared to USD 13,317,562 for the biennium 2018/19. USD 6,492,462 (79.8%) of the locally mobilised funds relates to COVID-19 response which is above minimum expectation of locally mobilised funding for country offices.

Irish AID COVID-19 540,000 : 7% DANIDA RESP COVID-19 467,275 : 6% CERF UGA 20-UF COVOD-19 934,579 : 11% 1,423,447 : 17% UNDP COVID-19 RESPONSE

2,285,399 : 28% AfDB EBOLA

846,836 : 10% DFID BRAER COVID-19 RESPONSE 534,478 : 7% KOICA RMNCAH 1,099,505 : 14% Irish Aid LAB SURV COVID-19

Figure 18: Donor contributions locally mobilised. Annual Report 2020

75 WHO COUNTRY SUPPORT CLUSTER (CSU)

• The donor funds were used to support Government of Uganda to implement various activities. During 2020, WHO supported government activities working with implementing partners mainly for COVID-19 response, Oral Cholera vaccination and Essential services.

Table 2: 2020 funds to Implementing partners to support Government activities

AFENET 147,404 Surveillance (Alert management) AMREF 57,212 Surveillance & Case management BAYLOR 257,186 Case management COVID-19 BAYLOR 52,345 Surveillance RESPONSE MAKERERE UNIV. LUNG INST. 118,586 Case management IOM 161,198 Points of Entry WALIMU 403,533 Case management & IPC

BAYLOR 183,956 IMCI in Eastern Uganda MakSPH 56,969 SARA Survey in Busoga region Malaria Consortium 60,784 Active surveillance (VPD) ESSENTIAL MMHF 60,626 Surveillance (CBDS) SERVICES UNAS 10,510 Coordination (NITAG) UVRI 59,761 Environmental surveillance WALIMU 9,364 Yellow Fever launch

ii. Compliance and risk management

• In 2020 there was end of year / Biennium found to be adequate to support business closure, preparations for audits with a Due operations. Diligence Review by DFID, and external • The quality of documentation to support audits by WHA auditors. Overall, 67% of payments was good and from the the external auditors recommendations suppliers’ circularization, there was a were closed within 6 months by the reduction in outstanding payments as at outgoing auditors and 33% await the year end. onboarding process of the new external auditors. • There was an increase in staff training and personal development by more staff • COVID-19 pandemics and global accessing the ilearn courses. Some courses lockdowns created new risks and scenarios such as working remotely helped by in WHO’s way of working. The Business keeping staff productive and feeling part Continuity Plan enabled the office to of the team while working from home. proactively respond to these scenarios. The Risk register was updated timely and the internal controls were reviewed and 76 WHO UGANDA COUNTRY OFFICE

iii. Coordination

• In addition to providing leadership and Supply Chain working group technical guidance to the Ministry and by deploying personnel and partners, WHO also made contributions managing supplies for EVD preparedness and COVID-19 to the NTF Logistics Pillar and the response. iv. Information Community Technology (ICT)

• During the year 2020, WHO Uganda • Increasingly, WHO staff are being equipped increased Internet Bandwidth Backed up with mobile computing (Laptops, Internet, and the speed from 10kbps to 20 Kbps Voice, Mobile phones and accessories) to with a new additional Link. able to work virtually.

v. Human resource management

• At the end of 2020, WHO Uganda had a (Special Service Agreement workforce of 129 staff of which 46 are contracts). There are seven staff holding long term contracts and 83 experts (International staff) are holders of short-term contracts hired at the WCO. Overall, 41% are female while 59% are male. to support EVD preparedness, COVID-19 response and other health emergencies

Figure 19: WCO Uganda Workforce

Female 53 [12%]

Male 76 [59%] Annual Report 2020

77 WHO COUNTRY SUPPORT CLUSTER (CSU)

Figure 20: WCO Workforce by gender and type of contract

Table showing Male and Female Workforce

46 50 45 37 40 30 35 30 25 16 20 15 10 5 0 Male Female

Long term contracts Short Term Contracts (SSAs

• The year 2020 saw establishment of • Human Resource Action Plans (HRAPs) objectives, mid-year and end of year for recruitment, contract renewals or performance reviews executed at 80% for separation were initiated timely as per all staff members within the established WHO policy. timeframes.

vi. Staff Welfare under the UN Wellness Group

• Throughout the year, the UN Wellness There was increased attention to staff Group led by WHO supported by the UN health and wellbeing through improved Resident Coordinator and the UN Country services at the UN Clinic and engagement Team, improved engagement and well- with accredited private health institutions. being of UN staff and their dependents.

vii. UN COVID-19 Supply Chain Task Force

• At the beginning of 2020, WHO used and COVID-19 pandemic. During the its stock of Infection Prevention and year, WHO directly procured critical Control supplies including Personal supplies and services locally and Protective Equipment (PPEs) to internationally valued at USD 1, support Cholera response, Ebola 640,125 representing 62.8% and Virus Disease (EVD) preparedness 37.2% respectively. 78 WHO UGANDA COUNTRY OFFICE

• Due to the unprecedented scale of the • The Task Force, co-chaired by WHO and COVID-19 pandemic, many countries WFP, provided strategic direction and were affected by global supply shortages. ensured that supply chains were driven by Under the leadership of the UN Secretary- strategic and tactical health and medical General and WHO Director-General, the priorities and that the most critical gaps COVID-19 Supply Chain Task Force was in supplies were identified and met timely. established in April 2020 to improve In 2020, WCO/Uganda, through the Portal the availability of essential supplies for procured supplies worth USD 2,170,814, COVID-19. as indicated in figure 21 below.

Figure 21: WCO Procurement through the Portal

248,236 [12%]

1,006,463 [46%]

916,115 [42%]

PPE’s Biomedical consumables and equipment Laboratory supplies

viii. Transport support to emergency response.

• During the year 2020, WHO Uganda at USD 788,387.98 (See Table 3 below). with support from donors supported The major expense areas were sample response to COVID-19 pandemic transportation, contact tracing and and other emergencies by emergency coordination. providing transportation valued Annual Report 2020

79 WHO COUNTRY SUPPORT CLUSTER (CSU)

Table 3: WCO Support to COVID-19 Response Transport

S/N Activity Name Amount (UGX) Amount (USD) Percentage 1 Alert Management 208,750,000 57,035.52 7.2% 2 Contact Tracing 858,750,000 234,631.15 29.8%

3 Sample Transportation 732,000,000 200,000.00 25.4% 4 Rapid assessment Teams 105,000,000 28,688.52 3.6% 5 STOP 53 Teams 319,500,000 87,295.08 11.1% 6 Yellow Fever Campaigns 10,500,000 2,868.85 0.4% 7 OCV Campaigns 62,500,000 17,076.50 2.2% Regional Hub Field 8 588,500,000 160,792.35 20.4% Coordination TOTAL 2,885,500,000 788,387.98 100.0%

WHO procured various logistics and supplies including motorcycles for the COVID-19 response. PHOTO: WHO UGANDA 80 WHO UGANDA COUNTRY OFFICE

ix. Customs Clearance

• WCO has good working relationship with partners such as Uganda Revenue Authority, Ministry of Foreign Affairs, National Drug Authority, National Bureau Of Standards, Ministry of Health and this facilitated timely clearing and delivery of emergency supplies without delay.

x. Distribution and supply management

• WHO worked with partners including National Medical Stores, World Food Programme and Uganda Virus Research Institute to ensure proper storage and distribution of supplies and temperature controlled laboratory diagnostics.

• WHO also received inkind donation from KOICA and Jack Ma of supplies worth USD 289,000 and USD 22,043 respectively. The donations were well stored and distributed with guidance from the technical units of the WCO.

• The eELMIS online took that was introduced in October 2019 by WHO and USAID/MSH enabled districts and regions to access quality data which facilitated quick management decision across all levels of the emergency supply chain thus ensuring greater commodity security, information sharing, timely ordering of supplies leading to lives saved and better health outcomes during emergency situations.

xi. Financial Management

• In September 2020, there was a training for all suppliers on the payment process requirements and the implementation of Electronic Fiscal Receipting and Invoicing Solutions (EFRIS) resulting into efficient and timely submission and processing of eTax Invoices.

• EFRIS is an initiative under the Domestic Revenue Mobilization Program whose aim is to address the tax administration challenges relating to business transactions and issuance of receipts. It is a new smart business solution used to record Annual Report 2020

81 WHO COUNTRY SUPPORT CLUSTER (CSU)

business transactions and share the information with URA in real time (concurrently). Refund claims using e-receipts or e-invoices has been fast-tracked given that the information is available in the URA system.

• In view of the new iSupplier for Supplier Registration Portal and enhancements to the current AP self-service page, there was a training conducted by the Global Service Centre to enable registration of suppliers. This was aimed at having all registered suppliers view the status of their payments and update their bank details accordingly.

The Right Honorable Prime Minister of Uganda Dr Ruhakana Rugunda received immunization cold chain equipment worth USD 9 million procured with support from WHO, UNICEF and GAVI. PHOTO: WHO UGANDA 82 WHO UGANDA COUNTRY OFFICE

CHALLENGES

• Delays to liquidate encumbrances before • There was national and indeed global the award end dates thus resulting into ex- shortage of critical medical supplies for batches or returning funds to the donors the COVID-19 pandemic. Several suppliers due to the slow rate of implementation of were not able to complete delivery of activities. orders in time or even deliver at all. The pandemic brought in unprecedented • Efforts were made to ensure that WHO logistics challenges, which constrained staff have good ICT equipment, however the response. some users still have old equipment which are overdue for replacement especially considering synergy being implement in WHO.

LESSONS LEARNT

• It is important to have regular • Critical IPC and PPEs supplies with long communication with suppliers and obtain shelf life need to be adequately stocked at Statements of Account to determine central and regional levels to cater for any the outstanding payments and mitigate eventualities. possible reputational risks.

WAY FORWARD

• Ensure that all suppliers are registered • The local producers that ventured in in iSupplier Registration Portal to ensure the production of PPEs such as masks, timely payment for goods and services. sanitizers ought to be supported to enhance quality standards and sustain • Continuous revision of work plans production. The global travel and including aligning planned costs, adjusting transportation restrictions during the award budget to ensure compliance Covid19 pandemic demonstrated the with the International Aid Transparency need for in country capacity to produce Initiative (IATI) output reports. critical basic medical supplies. • Continuously identify funds and replace equipment for both technical and support staff. Annual Report 2020 83

SISTER FLORENCE WAISWA GOES HOME TO REST

As we went to press for this report, sad news She had a great skill of delivering practical sessions reached the country office about the demise of our which made trainees gain confidence to perform life- colleague Senior Nurse Florence Waiswa. She lost saving tasks. the fight to COVID-19 which she was in the middle of fighting as an Infection Prevention and Control (IPC) “The demise of Sister Florence is not only a consultant based in Southwestern Uganda overseeing loss to WHO but Uganda as a whole. She served the 6 districts. country diligently in her capacity as an IPC expert to ensure that health workers are safeguarded from the The fact that Florence was killed by COVID-19 deadly COVID-19 but unfortunately, we lost her to the and right at the frontline of duty speaks volumes about same,” said Dr. Yonas Tegegn Woldemariam, the WHO her commitment to saving lives of her fellow Ugandans Representative to Uganda. and humanity in general. She died doing what she loved most – preventing disease infections and saving Her son Mr Anthony Wakabi echoed the same lives. sentiments noting that “Mother was a midwife at home. Nursing the neighbourhood in Mutungo and Kitintale. When Ebola Virus Disease (EVD) broke out in Despite resistance from the family, she went to Liberia. West Africa, Florence was among the 14 health workers When she came back alive, we knew she belonged to from Uganda who readily volunteered to go to Liberia the world so we let her do what she was put on earth and assist under the World Health Organization (WHO). to do. Taking care of the sick and controlling the spread of diseases. Mother, you are a hero not only in Uganda In Liberia, Florence and her team under the but also Africa!” leadership of the equally indomitable Dr Anne Atai Omoruto (RIP) mounted arguably one of the best case Her colleagues in the IPC department, Sister management response to EVD on record. The setting Doreen Nabawanuka noted that “Sister Florence will was at the Ebola Treatment Unit (ETU) called Island be remembered as a hero to her country and to us that Clinic in Monrovia City, which was manned exclusively worked closely with her. We are more determined to by the Ugandan contingent. This ETU recorded one fight this deadly pandemic than ever before.” of the highest recovery rates of EVD patients during that outbreak! At the same time, Florence and her Given Florence’s contribution and dedication colleagues trained over 1,000 health workers on IPC to saving lives, we take inspiration and determination who eventually contributed to stopping the outbreak. to do more for humanity in the succinct words of the Such was their dedication and commitment to work Victorian Poet Christina Rossetti: that they were publicly recognized by the President of “When I come to the end of the road and the Liberia Her Excellency Ellen Johnson Sirleaf. sun has set for me, I want no rites in a gloom filled In Uganda, the soft-spoken Florence participated room. Why cry for a soul set free? Miss me a little but in different disease outbreak responses usually not for long for this is a journey we all must take concentrating on her area of expertise – IPC. In that and each must go alone. It is part of the master role, thousands of young and old health workers plan. A step on the road to home. Miss me, but who interface with dangerous infectious diseases let me go”. went through her experienced mentoring hands. Florence, we miss you but must let She was a dedicated field officer who set out to you go. We shall continue the fight. Rest in achieve her purpose at all costs. Occasionally, eternal peace disease warrior until we meet she pushed her leave forward to achieve a given at home task and rarely took leave on public holidays. WHO Uganda Country Office http://www.afro.who.int/countries/uganda Plot 60 Prince Charles Drive, Twitter @WHOUganda P. O. Box 24578 Kampala - Uganda Facebook World Health Organization Uganda Tel: +256 414 335500 [Reception] Flickr WHO Uganda